“Wisdom should not be taken for evidence”

My new favourite quote comes from a recent paper by Alberto Zanchetti , Guido Grassi and Giuseppe Mancia in the May 2009 Journal of Hypertension.

…[W]isdom should not be taken for evidence…

The paper’s full abstract:

The evidence for two recommendations of all major
guidelines on hypertension is critically discussed. The ?rst
recommendation is that of initiating antihypertensive drug
treatment when systolic blood pressure is at least 140 or
diastolic blood pressure at least 90mmHg in patients with
grade 1 hypertension and low or moderate total
cardiovascular risk, and even when blood pressure is in the
high normal range in patients with diabetes and previous
cardiovascular disease. The second recommendation is
that of achieving systolic blood pressure levels below
140mmHg in all hypertensive patients, including the elderly,
and values below 130mmHg in patients having diabetes
and high/very-high-risk patients. Critical analyses of the
results of available trials show that the evidence is scanty
for both recommendations. Nonetheless, they can be
accepted as prudent statements, as antihypertensive
agents are very well tolerated and lowering systolic blood
pressure below 130mmHg appears well tolerated.
However, wisdom should not be taken for evidence, and
simple trials should be designed to look for more solid
evidence in favour of current recommendations. J Hypertens

The evidence for two recommendations of all major guidelines on hypertension is critically discussed. The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in patients with diabetes and previous cardiovascular disease. The second recommendation is that of achieving systolic blood pressure levels below 140mmHg in all hypertensive patients, including the elderly, and values below 130mmHg in patients having diabetes and high/very-high-risk patients. Critical analyses of the results of available trials show that the evidence is scanty for both recommendations. Nonetheless, they can be accepted as prudent statements, as antihypertensive agents are very well tolerated and lowering systolic blood pressure below 130mmHg appears well tolerated. However, wisdom should not be taken for evidence, and simple trials should be designed to look for more solid evidence in favour of current recommendations.

(Emphasis added.)

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4 People have left comments on this post



» hypertensive medications said: { Sep 8, 2009 - 02:09:36 }

I would have to agree that evidence is indeed scanty when it come to guidelines for prescribing high blood pressure medications. I wonder if the report suggest prescribing antihypertensive medications when all other healthy alternatives such as diet and exercise have been tried and shown to not work?

» deborahb said: { Sep 8, 2009 - 09:09:59 }

>However, wisdom should not be taken for evidence<

On the one hand, I love it, & think it should be a more frequent conclusion.

On the other: death to the status quo!

There, I think that about sums it up.

» Chris Lawson said: { Sep 8, 2009 - 09:09:33 }

To Hypertensive Medications:

I wouldn’t agree that evidence is scanty. Hypertension is one of the most thoroughly studied problems in medicine. This paper was pointing out the evidentiary deficiencies in two particular recommendations (which I also find controversial, especially the second). Also, hypertension guidelines routinely recommend lifestyle changes first and only using medication first-line in severe hypertension or where there are other major risk factors for heart disease and stroke. This is certainly what the Australian guidelines recommend.

To Deb:

I didn’t realise how much you hated 70s/80s boogie rock bands.

» deborahb said: { Sep 8, 2009 - 12:09:07 }

>I didn’t realise how much you hated 70s/80s boogie rock bands.<

Oh, had I failed to make that clear?

Power chords, I hates them.

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