MH: Blood pressure management: individualized treatment based on absolute risk and the potential for benefit. Ann Intern Med

• Clinical practice often conflicts with epidemiologic evidence in the management of blood pressure. Anti-hypertensive therapy is generally prescribed if blood pressure exceeds some arbitrary level, thus committing many persons with minimal cardiovascular risk to long-term drug therapy. By contrast, below that level, re-gardless of cardiovascular risk, blood pressure reduc-tion is rarely sought. Epidemiologic data, however, consistently show a continuous, positive, linear rela-tionship of the height of both systolic and diastolic blood pressure with the incidence of stroke and heart attack. No threshold level distinguishes those who will have a cardiovascular event from those who will not. In fact, most heart attacks and many strokes occur among persons with "normal " blood pressures. Obser