To the Editor In an Original Investigation published in a recent issue of JAMA Internal Medicine, Brünstrom and Carlberg1 provide a novel viewpoint and welcome insight into the ongoing discussion about target blood pressure.
It makes intuitive sense that those with higher baseline blood pressures could derive greater benefit from blood pressure reduction than those with lower baseline blood pressure. However, I find it difficult to translate the results of the meta-analysis by Brünstrom and Carlberg1 to clinical practice because they do not describe the specific blood pressure end points that result in risk reduction. I would argue that a difference of 5 mm Hg may have a different outcome compared with a difference of 10 mm Hg or 20 mm Hg, or even the reduction of blood pressure to less than 140 mm Hg systolic, which was considered normotensive in the study.1 This lack of clarity makes the data hard to incorporate into actual decision making regarding patients. Additionally, explanation of how the baseline blood pressures were obtained in the 74 trials would help the reader in forming opinions regarding the validity of the trials and whether or not they are replicable in the clinical setting.1
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Donti N. Questionable Conclusions Regarding Blood Pressure End Points. JAMA Intern Med. 2018;178(4):574–575. doi:10.1001/jamainternmed.2018.0026
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