Intended for healthcare professionals


Thresholds for normal blood pressure and serum cholesterol

BMJ 2005; 330 doi: (Published 23 June 2005) Cite this as: BMJ 2005;330:1461

The root of the problem...


Westin and Heath [1] argue persuasively against the low thresholds of
blood pressure and cholesterol levels for preventive treatment of
cardiovascular disease as advocated in the European guidelines.[2]
Moreover, their concern about the widespread implementation of these
recommendations is entirely warranted.

However, the prospect of stopping the medicalisation of large
sections of the population seems remote. The ground has been too well
prepared. More than a generation of doctors has been programmed to accept
without question ever larger trials reporting ever smaller therapeutic
benefits. Steeped in the language of risk, they see nothing untoward in
prescribing long-term drug therapy to patients even though the vast
majority will not suffer from a cardiovascular event and an even higher
proportion stand to gain nothing whatsoever from many years of continuous

There are, of course, voices of dissent within the medical profession
but, while noting the authors’ opinions, there is no evidence of a
substantial rebellion. Certainly, few are willing to put their heads above
the parapet and even fewer will do so in future. How many GPs will decline
the financial inducements in their new contract and refuse to seek out
asymptomatic individuals for a cocktail of aspirin and statins? And how
many doctors in secondary care will have the courage to ignore guidelines
when compliance becomes mandatory for revalidation? [3]

For too long, the medical profession has danced to the tune of the
statisticians. [4] Insidiously, the obscure notions of risk have triumphed
over common sense. By stealth, a new paradigm in medicine has emerged:
this is the source of the grotesque pronouncements of committees of
experts and the explanation for how such nonsense is accepted without so
much as a murmur.


[1] Westin S, Heath I. Thresholds for normal blood pressure and serum
cholesterol. BMJ 2005;330;1461-2.

[2] De Backer G, Ambrosioni E, Borsch-Johnsen K, Brotons C, Cifkova
R., et al. European guidelines on cardiovascular disease prevention in
clinical practice. Third joint task force of European and other societies
on cardiovascular disease prevention in clinical practice. Eur Heart J

[3] Norcini JJ. Where next with revalidation? BMJ 2005;330;1458-9.

[4] Penston J. Fiction and fantasy in medical research: the large-
scale randomised trial. The London Press. London, 2003.

Competing interests:
None declared

Competing interests: No competing interests

01 July 2005
James Penston
Consultant Physician/Gastroenterologist
Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, North Lincolnshire DN15 7BH