Volume 199 - Issue 4
National guidelines for the management of absolute cardiovascular disease risk
Author: Robert D Grenfell
Med J Aust 2013; 199 (4): 244. || doi: 10.5694/mja13.10968
Published online: 2 September 2013
Published online: 2 September 2013
In reply: On behalf of the National Vascular Disease Prevention Alliance, I thank Usherwood for raising concerns about the evidence-based recommendations (EBRs) within
the Guidelines for the management of absolute cardiovascular disease risk.1 These guidelines inform a comprehensive, absolute risk approach to prevention of cardiovascular disease, and were approved by the National Health and Medical Research Council in 2012.
Usherwood’s concerns are specific to treatment recommendations ...
In reply: On behalf of the National Vascular Disease Prevention Alliance, I thank Usherwood for raising concerns about the evidence-based recommendations (EBRs) within the Guidelines for the management of absolute cardiovascular disease risk.1 These guidelines inform a comprehensive, absolute risk approach to prevention of cardiovascular disease, and were approved by the National Health and Medical Research Council in 2012.
Usherwood’s concerns are specific to treatment recommendations for second-line therapies in patients whose blood pressure is not adequately controlled by monotherapy (EBR 11 and EBR 12). EBR 12 states “If monotherapy does not sufficiently reduce blood pressure add a second agent from a different pharmacological class”.1 Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) belong to the same pharmacological class. Thus, EBR 12 recommends against prescribing an ARB to someone already taking an ACE inhibitor (and vice versa).
In future editions of the guidelines, EBR 11 will have ACE inhibitors and ARBs grouped under the same bullet point to avoid any confusion by the reader.
Competing interests
The National Vascular Disease Prevention Alliance is an alliance between Diabetes Australia, Kidney Health Australia, the National Stroke Foundation and the National Heart Foundation.
References
- National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. Canberra: National Vascular Disease Prevention Alliance, 2012. http://strokefoundation.com.au/site/media/AbsoluteCVD_GL_webready.pdf (accessed Jul 2013).