Treatment of hypertension and the potential adverse effects of overtreatment in ischemic heart disease must be evaluated using preischemic-event blood pressures rather than postevent data.
Does overtreatment of hypertension adversely affect outcomes in patients with ischemic heart disease?
This reply clarifies methodological differences in analyzing the J-curve phenomenon in hypertension treatment, emphasizing the importance of using pre-event treatment blood pressures.
In Reply. —The issue of BP control in ischemic heart disease is complex. Blood pressure may indicate the probability of experiencing a cardiovascular event or may serve as a marker of cardiovascular disease that has already occurred. Our report focused on the effects of treatment of hypertension and whether overtreatment would adversely affect outcomes. We included only studies involving treated patients and carefully ranked our treatment studies with a quality score that gave the highest value to those studies that used preischemic-event BPs. In contrast, MacMahon and Sharpe cite studies that included normotensive populations and used postevent BPs and baseline, rather than treatment, BP data. MacMahon and Sharpe cite data from the Hypertension Detection and Followup Program study that showed that the stepped-care group, including those with a history of myocardial infarction, had decreased mortality compared with the referred-care group. However, this is misleading since most patients in the study
Lisa Farnett (1991) conducted a letter in Hypertension and ischemic heart disease. Treatment of hypertension was evaluated. Treatment of hypertension and the potential adverse effects of overtreatment in ischemic heart disease must be evaluated using preischemic-event blood pressures rather than postevent data.