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Dietary Calcium Supplementation and Blood Pressure-Reply

Heiner C. Bucher, MD, MPH; Gordon H. Guyatt, MD, MSc; Deborah J. Cook, MD, MSc; Richard J. Cook, PhD
JAMA. 1996;276(17):1386. doi:10.1001/jama.1996.03540170030023.
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In Reply.  —Dr Cappuccio's aggressive attack on our work is particularly unfortunate because he has either not read or not understood our article. Cappuccio seems to think we suggested our findings have public health implications. In fact, we stated that "[i]t is unlikely that there are important underlying effects of calcium supplementation in reducing blood pressure in those with adequate calcium intake."Cappuccio criticizes our handling of the question of underlying hypertension. We pointed out in our article that the issue is not what investigators arbitrarily decide is high blood pressure, but the degree of overlap of blood pressure in putatively hypertensive and normotensive patients. Mean blood pressure in populations labeled normotensive vs those labeled hypertensive demonstrated a huge overlap, with many "hypertensive" populations showing lower mean blood pressures than many of the "normotensive" populations. The informal regression analysis we reported showed no relationship between mean blood pressure and the magnitude of


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