Published 29 June 2009, doi:10.1136/bmj.b2600
Cite this as: BMJ 2009;338:b2600

Letters

Drug prevention of hypertension

Assumptions and extrapolation

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

Law and colleagues’ conclusion, that blood pressure should be lowered in everyone over a certain age, rather than measured in everyone and treated in some, is derived from 147 disparate trials.¹ The trials have varying inclusion/exclusion criteria, and were conducted in patients aged 34-84, with follow-up of 0.5-8.4 years, and in those with hypertension, after myocardial infarction, with coronary artery disease without myocardial infarction, and with heart failure. Treatment was with various agents at varying doses and frequency and effect on blood pressure, with differing definitions of end point, but they still result in one simple conclusion—blood pressure measurement is useless.

Whereas figure 2 seems to show that antihypertensive agents are efficacious at a wide range of blood pressures (110->170/70->95 mm Hg), the higher blood pressures (>140 mm Hg) were in hypertension trials and the lower values in heart failure.^{2 3} Extrapolating these results to healthy people with systolic pressures of . . . [Full text of this article]

¹ Division of Cardiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02445, USA, ² St Luke’s Roosevelt Hospital and Columbia University College of Physicians and Surgeons, New York, NY, USA

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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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