Societies CVD risk-assessment programme/chart. Optimal cholesterol lowering should reduce the total cholesterol by 25% or LDL-cholesterol by 30% or achieve a total cholesterol of o4.0 mmol/l or LDL-cholesterol of o2.0 mmol/l, whichever is the greatest reduction (A). Glycaemic control should be optimised in people with diabetes, for example, HbA1c o7% (A). Advice is provided on the clinical management of hypertension in specific patient groups, that is, the elderly, ethnic minorities, people with diabetes mellitus, chronic renal disease, and in women (pregnancy, oral contraceptive use and hormone-replacement therapy). Suggestions for the improved implementation and audit of these guidelines in primary care are provided.

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SUMMARY Of 29 524 hospitalised medical patients monitored in a drug surveillance programme 1835 (6 2 %) received the xanthine oxidase inhibitor allopurinol. After the exclusion of skin reactions adverse effects were attributed to this drug in 33 (1.8 %) patients, the most frequent being haematological abnormalities (11 patients, 0 6 %) and diarrhoea and drug fever (5 each, 0 3 %). Adverse effects were dose-related. Reactions were unrelated to age, weight, reason for therapy, admission blood urea, or albumin concentrations. Acute exacerbation of gout was troublesome in 3 patients (1 in 600 exposed).Allopurinol achieves its major pharmacological effect through inhibition of the enzyme xanthine oxidase. The resultant alterations in purine metabolism explain its effectiveness in the treatment both of idiopathic gout and of hyperuricaemia secondary to blood dyscrasias, antineoplastic chemotherapy, and diuretic therapy

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