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ARTICLE |

The Need to Treat Mild Hypertension: Title and subTitle BreakMisinterpretation of Results From the Australian Trial FREE

John D. Abernethy, MB, CLB
[+] Author Affiliations

Reprint requests to Division of Public Health, School of Health Sciences, University of Massachusetts, Amherst, MA 01003 (Dr Abernethy).


JAMA. 1986;256(22):3134-3137. doi:10.1001/jama.1986.03380220100031
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Despite the clear-cut result of the Australian Therapeutic Trial in Mild Hypertension, which demonstrated prospectively the benefit of treatment of diastolic blood pressure in the range of 95 to 109 mm Hg, a retrospective analysis that classified subjects by the average diastolic pressure level attained during the trial purported to show an absence of treatment benefit at lower average diastolic pressures and a negative treatment effect at higher levels. However, the method of classification by average attained diastolic pressure introduced substantial selection bias, invalidating the retrospective analysis and rendering as spurious both the deleterious treatment effect and its lack of efficacy at lower diastolic levels.

(JAMA 1986;256:3134-3137)

REFERENCES

 Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA 1979;;242:2562-2571.
 Report by the management committee: The Australian Therapeutic Trial in Mild Hypertension . Lancet 1980;;1:1261-1267.
 Report by the management committee: Untreated mild hypertension . Lancet 1982;;1:185-191.
Freis ED:  Should mild hypertension be treated? N Engl J Med 1982;;307:306-309.
Alderman MH:  Mild hypertension: New light on an old clinical controversy . Am J Med 1980;; 69:653-655.
Kaplan NM:  Whom to treat: The dilemma of mild hypertension . Am Heart J 1981;;101:867-870.
Kaplan NM:  Mild hypertension: When and how to treat . Arch Intern Med 1983;;143:255-259.
Multiple Risk Factor Intervention Trial Research Group:  Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results . JAMA 1982;;248:1465-1477.
World Health Organization/International Society of Hypertension:  Guidelines for the treatment of mild hypertension , in Gross F, Strasser T (eds): Mild Hypertension: Recent Advances . New York, Raven Press, 1983;, pp 375-381.
Amery A, Brixho P, Clement D, et al:  Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial . Lancet 1985;;1:1349-1354.
Medical Research Council Working Party:  MRC trial of treatment of mild hypertension: Principal results . Br Med J 1985;;291:97-104.
Treatment of hypertension:  The 1985 results, editorial . Lancet 1985;;2:645-647.
Abernethy JD:  The Australian Therapeutic Trial in Mild Hypertension . Hypertension 1984;; 6:774-776.
Hardy RJ, Hawkins CM:  The impact of selected indices of antihypertensive treatment on all-cause mortality . Am J Epidemiol 1983;;117:566-574.
Lee KL, McNeer JF, Starmer CF, et al:  Clinical judgement and statistics . Circulation 1980;;61:508-515.

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 Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension . JAMA 1979;;242:2562-2571.
 Report by the management committee: The Australian Therapeutic Trial in Mild Hypertension . Lancet 1980;;1:1261-1267.
 Report by the management committee: Untreated mild hypertension . Lancet 1982;;1:185-191.
Freis ED:  Should mild hypertension be treated? N Engl J Med 1982;;307:306-309.
Alderman MH:  Mild hypertension: New light on an old clinical controversy . Am J Med 1980;; 69:653-655.
Kaplan NM:  Whom to treat: The dilemma of mild hypertension . Am Heart J 1981;;101:867-870.
Kaplan NM:  Mild hypertension: When and how to treat . Arch Intern Med 1983;;143:255-259.
Multiple Risk Factor Intervention Trial Research Group:  Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results . JAMA 1982;;248:1465-1477.
World Health Organization/International Society of Hypertension:  Guidelines for the treatment of mild hypertension , in Gross F, Strasser T (eds): Mild Hypertension: Recent Advances . New York, Raven Press, 1983;, pp 375-381.
Amery A, Brixho P, Clement D, et al:  Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial . Lancet 1985;;1:1349-1354.
Medical Research Council Working Party:  MRC trial of treatment of mild hypertension: Principal results . Br Med J 1985;;291:97-104.
Treatment of hypertension:  The 1985 results, editorial . Lancet 1985;;2:645-647.
Abernethy JD:  The Australian Therapeutic Trial in Mild Hypertension . Hypertension 1984;; 6:774-776.
Hardy RJ, Hawkins CM:  The impact of selected indices of antihypertensive treatment on all-cause mortality . Am J Epidemiol 1983;;117:566-574.
Lee KL, McNeer JF, Starmer CF, et al:  Clinical judgement and statistics . Circulation 1980;;61:508-515.
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