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(Hypertension. 2004;43:1166.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Variability in Response to Antihypertensive Drug Treatment

From the Department of Medicine, University of Miami School of Medicine, Fla.

Correspondence to Dr Barry J. Materson, Professor of Medicine, University of Miami (M854), 1150 NW 14th St (Suite 310A), Miami, FL 33136. E-mail bmaterson@med.miami.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

One of the definitions of the word pragmatic is "practical as opposed to idealistic." Many of the controversies regarding the issue of the use of race to any degree whatsoever in medical decision-making may be more of a result of tensions between pragmatic and idealistic positions on the issue.

The biological determinants of human intraarterial pressure are such that there is no precise cutpoint that can be defined for what can be considered to be "normal." Certainly, the statistical population norm is not a satisfactory cutpoint, because it is skewed to the right by those people whose blood pressures are biologically abnormal. How do we know that they are biologically abnormal? Here is another point of tension. We must make that determination based on the best epidemiological data on target organ consequences of elevated intraarterial pressure that we can gather. Reducing intraarterial pressure appears to be more important than the means by which it is reduced.¹ Currently, a systolic pressure of <120 mm Hg and a diastolic pressure of <80 mm Hg defines normal, but there is growing evidence that <115 mm Hg systolic and <75 mm Hg diastolic should be the cutpoint.^2–4

As if this were not enough uncertainty, add the fuel of measurement, physiological, geographic,⁵ and treatment variability of blood pressure to the philosophical fire. It is this variability within individuals and the overlap of group responses that is the central point of the study by Mokwe et al reported in this issue of Hypertension.⁶

In brief, . . . [Full Text of this Article]

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