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December 12, 1990

The Effect of Extracorporeal Shock Wave Lithotripsy on Blood Pressure-Reply

Author Affiliations

Indianapolis, Ind

Indianapolis, Ind

JAMA. 1990;264(22):2869. doi:10.1001/jama.1990.03450220030014

In Reply.—  We agree with Drs Williams and Thomas that the available evidence suggests that shock wave exposure is associated with small rises in BP. These BP changes have been detected as average rises in large patient groups previously treated by ESWL. Moreover, the average rise in the lithotripsy group is significantly larger than that observed in stone-forming controls not treated with lithotripsy. We also agree that these BP changes, although statistically significant, are not large enough to be considered clinically significant in the short term.However, we disagree with the notion that we should be focusing on incidence rates of hypertension rather than mean BP change. The observed incidence of hypertension, being simply a count of patients who have exceeded a threshold measurement, is a much less sensitive indicator of the effect of a treatment on BP than is the actual measured value of BP itself. This is