Author + information
- Chirag Bavishi, MD, MPH,
- Sripal Bangalore, MD, MHA and
- Franz H. Messerli, MD∗ ()
- ↵∗Division of Cardiology, Mount Sinai Health Medical Center, Icahn School of Medicine, 1 Gustave L. Levy Place, New York, New York 10029
Dr. Braillon is correct that our wording of the conclusion “wrongly suggested that benefits are for sure while risk is only potential.” However, we disagree with his suggestion of benefit/harm as the correct wording. Most patients who receive antihypertensive therapy for years and decades will neither be harmed nor be benefitted by it. This is clearly documented by the number needed to treat and number needed to harm which are 67 (for major adverse cardiovascular events) and 175 (for renal failure), respectively, in our study (1). Hence, benefits were almost 3 times more likely than harm. To prevent 1 event, 66 patients were treated without experiencing any benefit and 174 without experiencing harm. We therefore propose to use a qualifier for both, benefits and harm, and to amend the conclusion to “clinicians should carefully weigh potential benefits against potential risks.” Establishing an effective and efficient health care system is certainly an essential tool in management of any medical condition, including hypertension.
Dr. Naranjo and colleagues discussed various facets of acute renal failure with antihypertensive medications and intensive blood pressure (BP) control. The association between intensive BP control and acute renal failure is intriguing and needs further investigation. In the SPRINT (Systolic Blood Pressure Intervention) trial (2), composite renal outcome (reduction in estimated glomerular filtration rate, dialysis or renal transplant) between the intensive and standard BP treatment groups differed by baseline chronic kidney disease. However, in SPRINT, the renal events were lower than expected and the trial was terminated early, precluding any definite conclusions on long-term renal events. As stated in our paper (1), “Additional trials are needed to thoroughly investigate the effect of intensive BP control on renal function and serious adverse events.” We agree that BP variability, pulse pressure, and, to a lesser extent, mean arterial pressure are important parameters in BP management. However, data pertaining to optimal targets based on these parameters are scarce and well beyond the scope of our review.
Please note: Dr. Banaglore has served as a consultant to Daiichi-Sankyo, Pfizer, Abbott, Boehringer Ingleheim, and Merck. Dr. Messerli has served as a consultant to Daiichi-Sankyo, Pfizer, Abbott, Servier, WebMD, Ipca, and Menarini. Dr. Bavishi 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