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To the Editor The guideline from the panel appointed to the JNC 81 recommended drug treatment to lower BP for patients aged 60 years or older with systolic blood pressure (SBP) of 150 mm Hg or greater or diastolic blood pressure (DBP) of 90 mm Hg or greater. For patients younger than 60 years, the panel recommended medications for DBP of 90 mm Hg or greater. Both of these recommendations were classified as Grade A, presumably based on randomized clinical trials (RCTs). However, a systematic review that we coauthored in the Cochrane Database of Systematic Reviews2 found no evidence supporting drug treatment for patients of any age with stage 1 (mild) hypertension (SBP of 140-159 mm Hg, DBP of 90-99 mm Hg, or both) and no previous cardiovascular disease (ie, primary prevention).
Cundiff DK, Gueyffier F, Wright JM. Guidelines for Managing High Blood Pressure. JAMA. 2014;312(3):294. doi:10.1001/jama.2014.6596
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