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Comment & Response
April 2018

Questionable Conclusions Regarding Blood Pressure End Points—Reply

Author Affiliations
  • 1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
JAMA Intern Med. 2018;178(4):575-576. doi:10.1001/jamainternmed.2018.0029

In Reply We thank Dr Donti for her comments and the opportunity to clarify how blood pressure values from our study1 could be applied in a clinical setting.

We chose to stratify our analyses by baseline systolic blood pressure (SBP). We think that treatment effects by baseline SBP are more informative than achieved SBP because they better reflect the clinical situation. When a physician meets a patient and takes her blood pressure (BP), one wants to know if (additional) treatment to lower that pressure will reduce the risk of future cardiovascular events. One does not know, before treatment is initiated, what the achieved BP with any given treatment will be. Thus, translating our results into clinical practice becomes very easy. For primary prevention, patients with an SBP of 140 mm Hg or higher will likely benefit from treatment, whereas those with an SBP below 140 mm Hg will not.

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