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In Reply: Dr Baker suggests that there is sufficient evidence embedded in current trials to conclude that moderate elevation of SBP should be treated, but his inferences require a fair amount of speculation and are far from definitive. The treatment of moderate elevation in SBP may, on average, reduce the risk of cardiovascular disease and stroke in older patients. However, until a clinical trial directly addresses the benefit of treating this specific group, we believe that uncertainty about that benefit emphasizes the importance of shared decision making in these patients, which includes a discussion of the strength of the current clinical evidence.

Dr Sharma notes that obesity is an important cardiovascular risk factor, is strongly correlated with hypertension, and requires aggressive management. Obesity is not, however, included as a secondary cause of hypertension in the current JNC 7 (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood . . . [Full Text of this Article]

JoAnne Micale Foody, MD; Harlan M. Krumholz, MD
harlan.krumholz@yale.edu

Sarwat Chaudhry, MD
Yale University School of Medicine
New Haven, Conn

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