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[Correspondence] Blood pressure and cardiovascular outcomes: a closer look

Emmanuelle Vidal-Petiot and colleagues1 misinterpret the J-shaped relation between blood pressure and cardiovascular disease mortality, concluding that lowering systolic blood pressure to less than 120 mm Hg (or <70 mm Hg diastolic) is hazardous because mortality is greater than in patients with systolic blood pressure 120–129 mm Hg (or 70–79 mm Hg diastolic). In their cohort of patients with coronary artery disease the most likely reason for the increased risk in the patients with lower blood pressure is that some patients with coronary artery disease had heart failure, leading to lower blood pressure and higher mortality (reverse causality).