Editor—In a randomised equivalence trial over three years Birtwhistle et al tried to minimise care for essential hypertension if possible.1 Was it satisfactory to monitor blood pressures every six months rather than every three months?
The incomprehensible outcomes were three. The first was where blood pressure was measured, in doctors' premises or patients' homes by nurses. The second considered patients' satisfaction. There is no criterion by which ordinary patients are in any position to know if they ought to be satisfied. The third was adherence to treatment, which is crucially fundamental to any outcome. Twenty per cent of the time patients may not take their pills (and presumably do not need them) but are considered properly treated.
If essential hypertension causes stroke or coronary thrombosis then care is all there is on offer. Death in this group of 600 might be quite rare over three years. We are told that 67 dropped out over three years but not how many died. Of each group, 296 are not enough to base the whole care of the middle aged on, and neither are three years. This “work” and its outcome are contrary to the axiomatic and the real test is whether any doctor would leave himself or herself unmonitored for six months.
Blood pressure is negligently controlled by minimum, rather than maximum, assessments of the observation. Patients need their own lifelong oversight on blood pressure readings. They may well look after it better than any doctor. The technique should be taught at school.
Competing interests: None declared.
References
- 1.Birtwhistle RV, Godwin MS, Delva MD, Casson RI, Lam M, MacDonald SE, et al. Randomised equivalence trial comparing three month and six month follow up of patients with hypertension by family practitioners. BMJ 2004;328: 204-10. (24 January.) [DOI] [PMC free article] [PubMed] [Google Scholar]