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March 12, 1997

Nifedipine for Hypertensive Emergencies

Author Affiliations

Lahey-Hitchcock Clinic St Johnsbury, Vt

JAMA. 1997;277(10):787. doi:10.1001/jama.1997.03540340021013

To the Editor.  —The article by Dr Grossman and colleagues1 raises a critical issue that all physicians must face in sciencebased practice: are we basing our clinical and therapeutic decisions on our best sound logic and proven fact? The issue becomes especially critical when the risks of our actions might become life-threatening.However, I pause at the conclusion that we must abandon outright the practice of using nifedipine for the treatment of hypertensive emergencies. The authors cite the lack of data proving the benefit of this intervention, but lack of data is not equivalent to negative data. Is not the decision to abandon a practice based on the absence of data proving its benefit equivalent to endorsing a practice without supporting data? Significant morbidity is often an acceptable cost if we know that the therapeutic risk is outweighed by the benefit of therapy. Of note, both deaths reported secondary