Prof L Werkö i juninumret av SBUs
Several hundred doctors working in primary care have written to the
Secretary General of the WHO Gro Harlem Brundtland, protesting the
recommendations of a WHO-ISH expert report regarding treatment of
moderately elevated blood pressure. They emphasize that the
recommendations, if implemented, will increase the cost of treating these
patients without much benefit for patients or health services
SBU published a report on moderately elevated blood pressure in 1994
(report 121, also published in English as supplement 737, J Int Med, 1995)
based on a systematic review of all available evidence at that time. The
report strongly recommend that in moderately elevated blood pressure, the
patients should be treated, not the blood pressure figure. At that time
there was only scientific evidence that treatment sing diuretics or
beta-blockers had been shown to influence morbidity and mortality in these
patients. Studies on other type of medicines published after report 121
have demonstrated that these other medicines may also have the same, but
not any better, effect as the two originally recommended. SBU thus can see
no reason to change the recommendations from the earlier report.
It should be emphasized that the recommendations published, as coming
from the WHO, are the result of the deliberations of an expert committee,
appointed jointly by WHO and the International Society of Hypertension.
The recommendations thus are those of the expert committee and are not
endorsed by the WHO. The validity of the recommendations of the committee
has to be seen against the background that some of the members, to varying
extents, are supported by pharmaceutical companies selling blood pressure
lowering medicines. The WHO-ISH recommendations were furthermore presented
by a pharmaceutical company before the presentation scheduled by the WHO.
The reaction of members of the medical profession treating patients
with elevated blood pressure all over the world must be seen as a healthy
sign that evidence based medicine is starting to gain over the propaganda
from the pharmaceutical industry.
Professor Lars Werkö