SIR,-Professor WR Lee and Dr MR Moore'did not mention that low level exposure to lead can result in hypertension. 2'Europeans and North Americans have differing attitudes to the relation between lead and hypertension. Europeans tend to be uncritically dismissive and trivialise the relation, whereas North Americans uncritically embrace the association and consider that it has an appreciable impact on, public health. 4 Despite these cultural differences the evidence strongly points to a causal link between low levels of lead exposure and raised blood pressure, with the physiological mediators of stress-that is, catecholamines, etc-playing a critical part. 5 6

The views of Professor Lee and Dr Moore disagree with those expressed in the 1988 report of the Medical Research Council advisory group on lead and neuropsychological effects in children.'This report makes only weak and vague conclu-sions. It is not so bold as to dismiss a causal relation outright but does leave an overall impression that if the relation exists at all it is minor and trivial. As far as I know the Medical Research Council has not even addressed the issue of low level lead exposure and hypertension. This dismissive attitude to potential effects of low level lead exposure by a British, government agency with a national overseer role is in direct contrast with the climate in the United States, where this issue seems to have been reviewed ad nauseam. Where does the balance lie?