Stephen A. Martin, MD, EdM
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=L15-0234.
Martin S.; Effects of Blood Pressure Reduction in Mild Hypertension. Ann Intern Med. 2015;163:67. doi: 10.7326/L15-5103
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Published: Ann Intern Med. 2015;163(1):67.
TO THE EDITOR:
Sundström and colleagues (1) conclude that drug treatment “in the primary preventive setting is likely to reduce the risk for several important adverse health outcomes.” This finding is interesting given that the 2012 Cochrane review that they cite (2) found no evidence of mortality or morbidity benefit with drug treatment of mild hypertension. What changed?
The authors explain the different conclusions by stating, “Besides the inclusion of persons with diabetes or prior antihypertensive treatment, the disparity between the conclusions of this review and the one immediately preceding it is primarily attributable to statistical power. The present review nearly doubled the number of patients, quadrupled the number of cardiovascular events, and provides data on end points not available in the prior meta-analysis.” Having recently examined this literature with colleagues (3), I have a different interpretation. To gain statistical power, Sundström and colleagues' review combined high- and low-risk patients with mild hypertension, which is equivalent to mixing apples—that is, higher-risk persons with diabetes and prior treatment—with oranges—that is, persons without diabetes or prior treatment of hypertension.
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