National guidelines for the management of absolute cardiovascular disease risk

To the Editor: Concerns have been raised that the national Guidelines for the management of absolute cardiovascular disease risk1 recommend combining an angiotensin-converting enzyme (ACE) inhibitor with an angiotensin receptor blocker (ARB) for blood pressure reduction.2 Grenfell replied on behalf of the National Vascular Disease Prevention Alliance, stating that these agents are of the same pharmacological class3 and that the guidelines recommend using an agent from a different pharmacological class for second-line therapy. Therefore, he argued that the guidelines recommend “against prescribing” these agents in combination.3 This is incorrect.