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Bavishi et al. (1) comprehensively reviewed the intensive blood pressure–lowering trials in older hypertensive patients. However, the conclusion that “clinicians should carefully weigh benefits against potential risks” deserves comment.
First, this wording wrongly suggested that benefits are for sure whereas risk is only potential, showing our cultural misconception. Benefit/harm is the correct wording. Could Bavishi et al. (1) provide the number needed to treat to avoid 1 major adverse cardiovascular event per year? This timeframe is an issue considering the substantial discontinuation of treatment over time.
Second, the conclusion could have challenged the Byzantine debate of guidelines about the ideal blood pressure level, which may be missing the wood for the tree. The real-life setting has little to do with selected, motivated, and captive patients freely treated by leading investigators in a trial with costly quality assurance programs.
Developing and deploying systems of care that address barriers at the patient, health care provider, and health system level will lead to substantial reductions in hypertension-related burden (e.g., training for motivational interviewing to improve adherence, simplifying delivery of health care through task-sharing with nonphysician health workers, optimizing self-management with treatment supporters and new technologies, improving affordability of treatment and monitoring, and so on).
Please note: Dr. Braillon has reported that he has no relationships relevant to the contents of this paper to disclose. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper. Stanley Franklin, MD, served as Guest Editor for this paper.
- 2017 American College of Cardiology Foundation