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BMJ. 2007 September 22; 335(7620): 577–578.
PMCID: PMC1989012
Cardiovascular Prevention

Here's to risk assessment

Jonathan D Sleath, general practitioner

I was delighted to read the editorial suggesting that we should move away from the primitive “one threshold fits all” mentality for starting antihypertensive treatment and take a view based on the overall cardiovascular risk.1 We already do this when treating cholesterol for the purposes of primary prevention, so it is inconsistent not to use this approach for blood pressure, which is another continuous variable. The recent Joint British Societies' guidelines recognise this as the predicted cardiovascular risk rises with systolic blood pressure to 160 mm Hg,2 yet they are not used as a tool for assessing whether to treat hypertension.

This is part of the general problem that occurs when we assign arbitrary values to continuous and often fluctuating biological variables to create boundaries for disease labels. For example, bronchial hyper-reactivity can change quite notably over time, and it can be very difficult to decide whether the label of asthma is appropriate. Our target driven culture encourages the use of these labels, but I think that they are often not very helpful, and I often use asthma drugs in those whom I would not label as asthmatic.

Glucose metabolism represents another such variable, and I look forward to the day when I read an editorial suggesting that we abandon the World Health Organization's criteria for diagnosing diabetes, in favour of a decision tool for the treatment of abnormal glucose metabolism based on risk.

Notes

Competing interests: None declared.

References

1. Nash IS. Reassessing normal blood pressure. BMJ 2007;335:408-9. (1 September.) [PMC free article] [PubMed]
2. JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005;91(suppl V):v1-52. [PMC free article] [PubMed]

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