Much was made last month -- of the very large SPRINT blood pressure study results, purporting to support the thesis of "even lower" is better -- or, "ever lower" if you prefer -- for reducing cardiovascular risks. Cassels has admirably offered us the flip side -- the numbers needed to harm -- when a two-, or three-drug regimen drives those numbers down -- very, very low. Kidney problems -- up to and including renal failure -- emerge as one of those off-target effects, as providers ramp up the dosages. Do read all of his -- but these are his takeaways:
. . . .I decided to construct my own table using the individual Secondary Outcomes and Serious Adverse Effects that were found to be ‘statistically significant’ (i.e.: had a P-value lower than 0.05). As you see in the list below, here’s how many people need to be treated to be helped or harmed in the “intensive” blood pressure group compared to “standard” therapy:
125: Number needed to treat to prevent one case of heart failure.
167: Number needed to treat to prevent one death by cardiovascular causes
83: Number needed to treat to prevent death by any cause
100: Number needed to harm to cause one case of hypotension
167: Number needed to harm to cause one case of syncope
125: Number needed to harm to cause one case of electrolyte abnormality
56: Number needed to harm to cause one case of acute kidney injury or renal failure
42: Number needed to harm to cause one serious adverse event. . . .
Those rather low numbers needed to harm, at higher dosages -- should give us all pause. So -- do take the NEJM Sprint article with this in mind, as you settle into your easy chair, after that second helping of bacon-infused smoky turnip greens and buttery cornbread. I know I will. Safe and Happy Holidays, to all! I'm off. . . .
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