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Systematic review with meta analysis
Blood pressure-lowering treatment should be based on the level of cardiovascular risk, not on the level of blood pressure
  1. Malcolm R Law
  1. Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK
  1. Correspondence to: Dr Malcolm R Law, Queen Mary University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK;{at}

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The 2008 report of the Health Survey for England included a chapter on ‘cholesterol’ (with no mention of ‘hypercholesterolemia’) and another on ‘hypertension’ (with no mention of ‘blood pressure’).1 This dichotomy echoed a prevalent view. Treatment guidelines advocated blood pressure-lowering drugs for everybody with blood pressure above a certain threshold (somewhat arbitrarily defined) but not for people with blood pressure below the threshold. There was a view (unsupported by evidence) that below the threshold reducing blood pressure did not reduce risk. However, cholesterol-lowering drugs were advocated for everyone at higher risk, irrespective of pretreatment cholesterol; the relationship with cardiovascular disease was correctly judged to be continuous.

There is strong evidence that blood pressure-lowering drugs should also be used in …

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