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February 2, 1990

Blood Pressure Reduction and the Risk of Myocardial Infarction-Reply

JAMA. 1990;263(5):661. doi:10.1001/jama.1990.03440050054026

In Reply.—  Compliance, or its absence, may, as Dr Rudd suggests, have affected patient experience. We have no data to suggest frequent wide blood pressure (BP) swings in the studied patients, nor did we find a relation between BP variability and outcome. Moreover, our systematic treatment program is designed to maximize adherence (measured by persistence in treatment), and BP control has been very high.1 Parenthetically, we do not agree with the characterization of our studied group as being "high risk": 10% had a prior cardiovascular disease, less than 5% had diabetes, one third were smokers, and 25% had an abnormality on an electrocardiogram, which we believe to represent the mixture found in the community.Staessen et al have correctly noted that the Cox analytical procedure does not test for curvilinear relationships. We did, however, treat BP fall as both a dichotomous and a continuous variable and found consistent results