The Pharmaceutical Journal
Vol 275 No 7358 p79
16 July 2005

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· Adverse events
· Supermarket pharmacy
· Research
· Regulation of medicines
· OTC statins
· Pricing (2)
· Pharmacy practice
· CPD
· Reciprocity
· Registration examination
· Veterinary pharmacy
· The Society
· Birdsgrove House (5)

Letters to the Editor

Research

Criticism of BP study

From Dr B. Curwain, MRPharmS

The news item about the “early morning BP surge in hypertensive patients” (PJ, 2 July, p8) is a classic case of research that looks at surrogate evidence rather than outcomes for patients. When we are looking at evidence, we should be searching for evidence of effectiveness in terms of what happens to our patients rather than simply measuring something that is easy to measure, which may, or may not, increase certain adverse health events.

Of course it is easy to see why studies such as that reported are done. The researchers, and particularly their sponsors, want us to make assumptions, which may not be correct, about the potential for adverse health outcomes. The paper concerned makes a comparison between the early morning blood pressure effects of an angiotensin receptor blocker and the ACE inhibitor, ramipril.

In reality, ramipril has a huge body of evidence behind it demonstrating its health benefits for large groups of people with cardiovascular disease. There is also some evidence that ACE inhibitors are associated with better health outcomes than the sartans. The ACE-induced bradykinin build-up, which can cause the cough, is probably the reason. Bradykinin is a potent stimulator of nitric oxide formation by vascular endothelium and also stimulates prostacyclin formation.

Brian Curwain
New Forest Primary Care Trust

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