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Comment & Response
December 2017

Safety vs Efficacy of Lowering Blood Pressure—Reply

Author Affiliations
  • 1Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
  • 2Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
JAMA Cardiol. 2017;2(12):1399-1400. doi:10.1001/jamacardio.2017.3543

In Reply We agree with Bavishi et al and Gąsowski et al that adverse events are an important consideration during antihypertensive treatment. However, while potential adverse effects of intensive systolic blood pressure (SBP) reduction should be considered carefully, to our knowledge, these effects have not yet been consistently proven in published clinical trials. Conversely, several published clinical trials and meta-analyses,1-3 including our network meta-analysis,2 which compared a wide range of achieved SBP levels, have documented important benefits of intensive SBP reduction below current treatment guidelines on cardiovascular disease (CVD) in patients with hypertension who are at high risk for CVD. Furthermore, these studies have demonstrated that intensive SBP reduction lowered all-cause mortality. Therefore, the benefits of intensive SBP reduction are of substantial clinical import and likely outweigh the potential adverse effects.