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"Ok, so I have a whole string of mostly women over 80 who no matter what I do, I cannot get their systolic below 180/190 without serious side-effects, both perceived by the patient ie "I feel awful doctor" and physiological ie urea and creat rising through the roof. So what do I do? Leave them alone, or work my way through the BNF? Have I misunderstood the studies?" David As I' m sure you are the aware the SHEP study demonstrated a benefit for these patients. However what is the benefit of a theoretical decrease in the risk of stroke compared to a real drop in quality of life caused by side effects. In some of these patients i just accept a high blood pressure. You could always ask the patient her view. Trouble is while the 30 somethings like to dictate their healthcare needs the eighty somethings are more likely to want to be dictated to. BTW I usually find Ca antagonists helpful in this age group. Ian %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%