RT Journal
A1 Gambassi G, Lapane K, Hume AL, Carbonin P, Bernabei R
T1 Antihypertensive therapy in the elderly: Evidence-based guidelines and reality
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1999
FD July 26
VO 159
IS 14
SP 1622
OP 1622
DO 
UL http://dx.doi.org/
AB 
These limits are not newly recognized. Some 38 years ago, questions arose regarding the direct application of results coming from trials as a successful strategy to advance the overall health of the individual or the population.1 In fact, while it has been highlighted that the relative benefit of interventions is constant across defined subgroups within trial populations,2 the heterogeneity of effect within the general population may well be substantial. The problem is that randomized trials are by design not able to address this heterogeneity. Trials examine primarily medical interventions; randomization (if successful) permits comparisons of interventions not confounded by the "individuality" of patients.3 Here is the paradox of the trial: it is the best way to assess whether an intervention works but is arguably the worst way to evaluate who will benefit from it. This contradiction leaves a gap in the evidence available for clinicians.