Hypertension strategies in the third millennium: Conservatism, evidence and the folly of speculation

Abstract

Conventional wisdom has recently been found wanting in major studies of both coronary artery disease and diabetes. We have learnt that the mechanical pursuit of the perfect coronary lumen may not improve outcome (1) and that the relentless pharmacological pursuit of lower Hba1c in diabetes may cause harm (2). A recent perspective in the New England Journal of Medicine (3) challenges us to be cautious when our assumptions assume the mantle of fact. The authors observe; 'it is increasingly apparent, that the specific strategies used to modify (vascular risk factors) make a critical difference in patient outcomes' and note that 'guidelines and performance measures (should) reflect the evidence about interventions that are known to be beneficial'. © 2008 The Author.