Intended for healthcare professionals

Letters Drug prevention of hypertension

Authors’ reply

BMJ 2009; 338 doi: (Published 29 June 2009) Cite this as: BMJ 2009;338:b2602
  1. Malcolm Law, professor of epidemiology and preventive medicine1,
  2. Joan K Morris, professor of medical statistics1,
  3. Nicholas Wald, professor of epidemiology and preventive medicine1
  1. 1Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary, University of London, London EC1M 6BQ

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

    Absolute risk should determine the indication …

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