The series of articles in this weeks BMJ by Law et al are very
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: No competing interests