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Comment & Response
December 2017

Safety vs Efficacy of Lowering Blood Pressure

Author Affiliations
  • 1Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
JAMA Cardiol. 2017;2(12):1398. doi:10.1001/jamacardio.2017.3537

To the Editor When choosing an antihypertensive medication or a therapeutic goal, one should weigh benefit against risk. Unfortunately, in their recent network meta-analysis, Bundy et al1 show only the bright side when they declare that randomized groups with a mean achieved systolic blood pressure (BP) of 120 to 124 mm Hg had lower cardiovascular and all-cause mortality outcomes compared with other groups. Obviously, the conclusion supporting a more intensive BP control is solely based on evaluation of efficacy outcomes, and safety outcomes are completely missing in the data set used by Bundy et al.1 As most clinicians would agree, safety is an issue of paramount importance with these exceedingly low BP target levels. In a 2017 meta-analysis, Bangalore et al2 evaluated both efficacy and safety outcomes of various BP targets. They documented that for all end points, systolic BP levels less than 130 mm Hg provided optimal balance between safety and efficacy. This is in line with the report with 11 years of follow-up of patients from the International Verapamil (SR)/Trandolapril Study, which indicated that the target of 130 mm Hg for systolic BP was optimal.3,4

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