—The issue of BP control in ischemic heart disease is complex. Blood pressure may indicate the probability of experiencing a cardiovascular event or may serve as a marker of cardiovascular disease that has already occurred. Our report focused on the effects of treatment of hypertension and whether "overtreatment" would adversely affect outcomes. We included only studies involving treated patients and carefully ranked our treatment studies with a quality score that gave the highest value to those studies that used preischemic-event BPs. In contrast, MacMahon and Sharpe cite studies that included normotensive populations and used postevent BPs and baseline, rather than treatment, BP data.MacMahon and Sharpe cite data from the Hypertension Detection and Followup Program study that showed that the stepped-care group, including those with a history of myocardial infarction, had decreased mortality compared with the referred-care group. However, this is misleading since most patients in the study
Farnett LE, Linn WD, Mulrow CD. The J-Curve Phenomenon and the Treatment of Hypertension-Reply. JAMA. 1991;266(1):65–66. doi:10.1001/jama.1991.03470010068027
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