Thresholds for normal blood pressure and serum cholesterol

Lower thresholds mean that 90% of people over 50 years are identified as patients

For several years, disagreement has been growing in health services about ever lower thresholds for “normal” blood pressure and serum cholesterol, the most common biological risk factors for cardiovascular disease. This was most publicly expressed in 1999, when more than 800 doctors, pharmacists, and scientists from 42 countries signed an open letter to the then director general Gro Harlem Brundtland, outlining fears that the World Health Organization's new hypertension guidelines would result in increased use of antihypertensive drugs, at great expense and for little benefit.1 2 The simplistic linear structuring of many research questions and the extrapolation of research results over prolonged and unstudied time periods produce guidelines that make many doctors, and particularly general practitioners, feel uneasy about the high proportion of their patients who are being labelled as sick.

General practitioners are aware of the side effects of undue medicalisation and tend to question the external validity of randomised controlled trials under experimental conditions.3 They …