Published 29 June 2009, doi:10.1136/bmj.b2596
Cite this as: BMJ 2009;338:b2596

Letters

Drug prevention of hypertension

Law’s flaw?

The first 150 words of the full text of this article appear below.

Law and colleagues argue that the benefits of reducing blood pressure will accrue across a range of patients to make it worth their while swallowing a pill a day.¹

They refer to meta-analysed data which excluded all those patients with initial normal blood pressures yet state: "Our results indicate that the use of blood pressure lowering drugs should not be limited to people with high blood pressure." They add: "The proportional reduction in disease events for a given blood pressure reduction was the same irrespective of blood pressure before treatment, down to levels of 70 mm Hg (or lower) for diastolic blood pressure."

Giving a hypotensive agent to someone with, say, a blood pressure of 100/60 mm Hg is likely to do more harm than good, and I would want evidence from randomised controlled trials before I treat people with normal blood pressure. I might dub this "Law’s flaw." Law . . . [Full text of this article]

¹ Surgery, Newport, Pembrokeshire SA42 0TJ

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Authors’ reply

Malcolm Law, Joan K Morris, and Nicholas Wald
BMJ 2009 338: b2602. [Extract] [Full Text]

Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies

M R Law, J K Morris, and N J Wald
BMJ 2009 338: b1665. [Abstract] [Full Text] [PDF]

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