Paper courtesy of twitter (Eric Topol), a paper suggesting that choice of blood pressure lowering medication has an on average benefit of 4.4mmHg.
Jon
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Does it really at 4.4 mmHg? I would love to see the effect size calculations, but I can’t quickly find the full paper. I also would love to know what they mean by “Large differences were excluded for the choices of lisinopril vs candesartan and hydrochlorothiazide vs amlodipine.” This study’s endpoints are also short-term and only related to BP. What of the medium or long-term implications for drug choice for renal, cerebrovascular or cardiac disease endpoints?
I hope someone can find the full paper and uploads it. I want to be more startled than learning that we must treat people as individuals, and I would love to learn that it makes a measurable difference when we do. That would be good to know.
Will grab the full paper and post - 8 is between best/worst - 4 is average improvement.
Thanks, @jon_herries, for forwarding the actual paper. It turns out to be more interesting than the abstract allows and hints that the supplements contain further fascinating information on the study. So I have gone from passing an abstract on a topic of peripheral interest to actively searching for the paper’s supplements.
The summary from JAMA is reasonable. There is enough evidence of meaningful heterogeneity in responses between individuals to anti-hypertensives to warrant further investigation.
I am not confident from this study alone that the effect size of adjusting for genetic dimorphism will be meaningful. Namely, the effects seen in this study will be dwarfed by the impact of inequity regarding access to effective primary care or poor medication compliance on population health outcomes.
Equally, acknowledging and giving voice to the diversity in our society has its benefits, even at the individual level.
Yes - I hoped you might mention equity, it means I get to add my other favourite link of the moment:
Hypertension in adults: the silent killer - bpacnz
And then ask the question about self-initiation and management of blood pressure lowering medication… (hint I want to work on this).
Jon
Oh, I like that. Thanks for sharing. Add diabetes into the mix, and I would be keen to join you in thinking about using POC screening devices and new ways of working to empower communities to self-manage better. That doesn’t sound like a hard sell internally.
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