We thank Rigter and Koffeman1 for their comments on our paper.2 The aim of this study was to explore the feasibility and consequences of a re-evaluation programme for patients without target organ damage who were treated for hypertension and/or hypercholesterolemia in general practices
We have shown that stopping medication of itself can be assumed to be safe, as no important adverse effects took place during the 6-month follow-up. As stated in the discussion section of our paper, we agree that until now it is not known what the morbidity and mortality will be in the discontinuing versus the continuing group in the next 10 years. However, if pretreatment levels of blood pressure and cholesterol were unknown, we have chosen to assume high levels of systolic blood pressure (180 mmHg) and total cholesterol to HDL-cholesterol ratio (8.0) to minimise the number of underestimated levels. Therefore, even if the blood pressure or lipid profile would change during follow-up, it would not alter the estimated low risk of cardiovascular mortality. Consequently, presenting data on these variables would thus have no additional value. Further, as also mentioned in the discussion section, the new guidelines on cardiovascular risk management are based on extensive clinical evidence. Therefore, we assume that stopping superfluous medication in patients with a low risk of cardiovascular mortality will not, of itself, increase mortality rate.
With respect to the efficiency of this re-evaluation programme, we agree that the views of the GPs, nurse practitioners, and patients on discontinuing preventive cardiovascular medication seem to play a role in attendance and advising whether or not to stop medication, and restarting medication after withdrawal. Forthis reason, we have recommended in our paper further exploration of these views to enable better information to be given to patients and to overcome differences between GPs and nurse practitioners. This year, a cluster-randomised controlled non-inferiority trial to the cost-effectiveness of proactive implementation of the multidisciplinary guideline cardiovascular risk management versus usual care in currently treated patients with hypertension and hypercholesterolemia will be launched as a follow-up of our study. However, until the results of this new study are presented, based on our results and calculation in the discussion section, it seems useful to focus on young people and non-smokers!
- © British Journal of General Practice 2011
