BMJ 1996;313:1482 (7 December)

Letters

Treating hypertension in elderly people

Statistics cannot eliminate weaknesses in study design

EDITOR,--The main question studied by Juan Merlo and colleagues was: Did treatment of hypertension in elderly men (whose blood pressure was measured at one examination in 1982-3 and was classified as being</=90 mm Hg or >90 mm Hg) lead to more ischaemic cardiac events during follow up of 10 years?1 In the study hypertension was treated as a point exposure. With a complex health disorder such as hypertension, in which the time from the onset of an increase in blood pressure to diagnosis and treatment varies, such an approach introduces so much insecurity that it cannot be handled by statistical analysis. The treatment of individual patients as well as the effect on blood pressure might have changed several times during follow up, with varying effects on the result.

The authors state that confounding by indication (severity) was handled by the statistical analysis. However, . . . [Full text of this article]


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Relevant Article

Incidence of myocardial infarction in elderly men being treated with antihypertensive drugs: population based cohort study
Juan Merlo, Jonas Ranstam, Hans Liedholm, Bo Hedblad, Gunnar Lindberg, Ulf Lindblad, Sven-Olof Isacsson, Arne Melander, and Lennart Rastam
BMJ 1996 313: 457-461. [Abstract] [Full Text]

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