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Clinically and Statistically Significant Differences-Reply

Emmett B. Keeler, PhD
JAMA. 1986;255(14):1876. doi:10.1001/jama.1986.03370140074009.
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In Reply.—  We agree with Dr Fuchs that a 1.9 mm Hg reduction in diastolic blood pressure might not mean much for a particular patient, but an average drop of that size in a population of patients with hypertension could have large benefits. Such a drop normally comes from large reductions in some people averaged with many others who have no effects of the intervention. More important, except for the Multiple Risk Factor Intervention Trial, recent clinical trials show clear lifesaving benefits to control of even mild hypertension.Our study was much too small to show any significant effects of control on mortality, but two other large randomized trials definitively show that cardiovascular mortality falls when hypertension is controlled.1,2 These trials are supported by many longitudinal studies that show cardiovascular disease is associated with hypertension.3 Other trials have had samples that were too small to show statistically significant

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