Authors' reply

doi:10.1136/bmj.b2602

Published 29 June 2009, doi:10.1136/bmj.b2602
Cite this as: BMJ 2009;338:b2602

Letters

Drug prevention of hypertension

Authors’ reply

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

Our analysis of randomised trials showed that cardiovascularrisk decreases with blood pressure down to 110 mm Hg systolic,¹below which, as Lewis states (BMJ 2009;338:b2596, doi:10.1136/bmj.b2596),there is a lack of data. But systolic blood pressure exceeds110 mm Hg in 99% of people over 55,² after allowing for regressionto the mean.³ Three drugs at half standard dose would lowersystolic pressure from 110 to 100 mm Hg,¹ and such blood pressuresare not unusual in youth,² with no untoward effect.

Absolute risk should determine the indication for blood pressurelowering drugs, as Bower states (BMJ 2009;338:b2597, doi:10.1136/bmj.b2597),but this depends more on age than blood pressure. The averagerisk of a coronary heart disease event or stroke in the next10 years is about 8% in a 55 year old untreated man, 15% at65, and 31% at 75.⁴ ⁵ People over . . . [Full text of this article]

Malcolm Law, professor of epidemiology and preventive medicine¹, Joan K Morris, professor of medical statistics¹, Nicholas Wald, professor of epidemiology and preventive medicine¹

¹ Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary, University of London, London EC1M 6BQ

m.r.law@qmul.ac.uk

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