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Comment & Response
April 2019

Older People Might Be at Most Serious Risk in Antihypertensive Treatment—Reply

Author Affiliations
  • 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
  • 2Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
JAMA Intern Med. 2019;179(4):590-591. doi:10.1001/jamainternmed.2018.8619

In Reply We thank Tufan for highlighting the uncertainty relating to treatment of older patients with mild hypertension. In our study,1 we limited the analysis to patients younger than 75 years because our interest was in whether treatment was appropriate for low-risk patients. Our observational data were drawn from electronic health records from general practices in England and, as such, were representative of the population up to the age of 75 years, including presence of comorbidities. According to most clinical guidelines,2 patients 75 years or older should be considered at high risk of cardiovascular disease; hence, those patients were excluded from our study. In subgroup analyses, we did not find a difference between younger and older patients in the association between treatment and mortality or cardiovascular disease; however, these analyses may have been underpowered and, therefore, should be interpreted with caution.

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