Fear of adverse events should not prevent the use of appropriate antihypertensive drug therapy

A recent publication reported that Systolic Blood Pressure Intervention Trial participants with 10-year cardiovascular disease risk less than 11.5% derived more harm than benefit from intensive treatment. The authors consider that serious adverse events (SAEs) are of equal importance to that of either all-cause death or the primary composite outcome (myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes). Under this premise, one death would correspond to 2.7 SAEs and a primary outcome to 1.8 SAEs overall, and to be between 6 and 18 times as important as an SAE in the intensive treatment group. In our opinion, patient utility should be considered when clinical decisions are made for the treatment of hypertension.