Intended for healthcare professionals

Rapid response to:


Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials

BMJ 2003; 326 doi: (Published 26 June 2003) Cite this as: BMJ 2003;326:1427

Rapid Response:


The series of articles in this weeks BMJ by Law et al are very
fascinating indeed.
There is however some lack of evidence to support the sweeping changes in
treatment they propose.
As they discuss in this article there is no direct evidence to support the
assumption that there is an additive effect from double or triple therapy
causing a reduction in the number of cardio vascular events.
The assumption is based on an induction (lower BP = lower number of
events). We have seen previous assumptions based on such "induction" be
wrong (HRT effecting beneficial lipid-profiles leading to an assumption
that it must be cardio-protective).

Again the number of side effects are very much based on single studies and
extrapolation of assumed cumulative effects and is contrary to current
best practice regarding poly pharmacy.

The papers should point to future research required not change of

Competing interests:  
None declared

Competing interests: No competing interests

02 July 2003
Gert Martin Kaiser
PO30 1PR