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Invited Commentary |

Let’s Prioritize the Right Care for the Right Patients With Hypertension ONLINE FIRST

Paul Arthur James, MD1
[+] Author Affiliations
1Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City
JAMA Intern Med. Published online June 16, 2014. doi:10.1001/jamainternmed.2014.1000
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High-quality health care is often summarized as delivering the right care to the right patient every time. In this issue of JAMA Internal Medicine, Rodriguez and colleagues1 publish an important study using data from the Atherosclerosis Risk in Communities (ARIC) Study to further inform the debate about which patients should receive antihypertensive medicines every time to achieve goal blood pressure (BP) targets—but it also informs us about much more in the treatment of hypertension (HTN). This observational study among patients with HTN finds no additional risk among the participants in the standard systolic BP (SBP) cohort (120-139 mm Hg) compared with those in the low SBP cohort (<120 mm Hg). This finding differs from epidemiologic data that consistently suggests a linear relationship between rising SBP in a population and increasing rates of poor outcomes (eg, stroke, myocardial infarction [MI], heart failure [HF], and mortality). Based on this strong epidemiologic association, conventional wisdom has held that using medication to achieve lower BPs in patients with HTN should result in lower rates of stroke, MI, and HF, similar to those seen among persons who take no antihypertensive medications.

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