Response to John Morley

摘要

Dr. Morley's and my comments concerning this controversial treatment question include areas where we agree and disagree. I concur entirely with the points Dr. Morley makes with regard to important blood pressure measurement considerations-especially postural measurements-and exercising caution in approaching antihypertensive therapy. The major area of disagreement between us is focused on our disparate interpretations of the original Hypertension in the Very Elderly Trial (HYVET) results. First, as evident, for example, in the evolution of recommendations regarding estrogen replacement therapy, results from randomized controlled trials should trump even well-designed epidemiological studies. The majority of the epidemiological studies that Dr. Morley cites used mortality as their primary outcome. In very old adults, prevention of disability related to stroke or congestive heart failure is more often the treatment objective than extending survival per se.