Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: Dr Baker suggests that there is sufficient
evidence embedded in current trials to conclude that moderate elevation of
SBP should be treated, but his inferences require a fair amount of speculation
and are far from definitive. The treatment of moderate elevation in SBP may,
on average, reduce the risk of cardiovascular disease and stroke in older
patients. However, until a clinical trial directly addresses the benefit of
treating this specific group, we believe that uncertainty about that benefit
emphasizes the importance of shared decision making in these patients, which
includes a discussion of the strength of the current clinical evidence.
Foody JM, Krumholz HM, Chaudhry S. Systolic Hypertension in Elderly Persons—Reply. JAMA. 2004;292(20):2465-2466. doi:10.1001/jama.292.20.2466-a