Loss of reason.

Having read seven letters and the authors’ reply on the issue as to whether or not statin treatment should be off ered to people at low risk of cardiovascular disease (Nov 24, pp 1814–18), I was marvelling at the process of scientifi c reasoning that could weigh the pros and cons of a contentious issue in such a mature and logical manner. And then came the letter by Nicholas Wald and Malcolm Law. In it they support the use of statins in low-risk patients irrespective of the concentration of serum cholesterol, but then go on to propagate their previously voiced view (which was not relevant to the subject under debate) that “blood-pressurelower ing drugs should be off ered... irrespective of a person’s blood pressure”. There is a broad spectrum of blood pressure behaviour over 24 h that is characterised by periods of hypertension, hypotension (caused by drugs, meals, and exercise), and patterns of autonomic failure, as well as nocturnal patterns of dipping, nondipping, reverse, and extreme dipping. These varying manifestations become more common in the very age group (older than 50 years) in which Wald and Law recommend blind treatment. So let’s not throw aside methods such as 24-h ambulatory blood-pressure measurement. Such methods pro vide a means for carefully assessing pa tients with hypertension so that we can prescribe appropriate drugs in ap pro priate doses and 2 March of Dimes, PMNCH, Save the Children, WHO. Born too soon: the global action report on preterm birth. http://www.who.int/pmnch/ media/news/2012/preterm_birth_report/en/ index.html (accessed March 7, 2013). 3 NHS. Statistics on women’s smoking status at time of delivery: England, Quarter 3, 2011/12. http://www.ic.nhs.uk/pubs/wsstd1112q3 (accessed Nov 18, 2012). 4 Braillon A, Bewley S. The enigma of spontaneous preterm birth. N Engl J Med 2010; 362: 2032. 5 Mackay DF, Nelson SM, Haw SJ, Pell JP. Impact of Scotland’s smoke-free legislation on pregnancy complications: retrospective cohort study. PLoS Med 2012; 9: e1001175 thereby obtain blood pressure control without over treatment. One is put in mind of Bulgakov’s thoughtful observation: “There is no greater misfortune in the world than the loss of reason”.