Palliative care in general practice

These are not sufficient arguments for an editorial in the BMJ to recommend one class of ,3 blockade and should be accompanied by the proviso that measurements of blood pressure are only a sur- rogate: it is the prevention of cerebrovascular accidents and myocardial infarctions that matters.As a doctor treating patients with hypertension or ischaemic heart disease most days of the week, I tend to use low doses of the most j3I selective lipophilic agent, bisoprolol, for hypertension and the highest affinity non-selective agent, timolol, for ischaemic heart disease.These drugs have been selected on the basis of theoretical arguments and surrogate measures on which Cleophas and Kalmansohn and I agree.As a clinical pharmacologist unhappy at such evidence, I set up the East Anglian comparison of the two classes of drug in ischaemic heart disease that I mentioned in my editorial and included them in a long term randomised comparison of antihypertensive drugs that started in 1986.