Goal Blood Pressure in Treating Hypertension—Reply

In reply

Dr Ames raises an important issue about the relatively weak evidence available to support the recommendation for the lower goal BP of therapy in diabetic patients with hypertension that has been advocated by multiple expert committees and authorities over the past few years.^1- 3 However, there is both experimental and clinical evidence to support the goal of 130/80 mm Hg in addition to that provided in the HOT trial⁴ and the MDRD trial.⁵ Before considering that additional evidence, it should be noted that, in Dr Ames's own words, "The only impressive end point reduction in the diabetic cohort [of the HOT trial] with target diastolic BP of 80 mm Hg was cardiovascular mortality (P<.016)." Why would this significant reduction in mortality, even if it were not "the primary prespecified end point," not be accepted by even the most rigid and conservative observer as strong evidence for using the diastolic BP goal of 80 mm Hg?