-Evidence-based medicine is characterized by relative risk reductions and number needed to treat. This paper offers a concrete estimate with respect to the association between elevations in BP and declining life expectancy.
-Given the statistical methods employed and the era from which the data was gathered, numerous qualifications exist:
-The nature of the study only allows for an association between hypertension and life expectancy rather than a cause/effect relationship.
-The use of anti-hypertensives was not controlled for (however, the authors estimate that <10% of individuals were appropriately treated).
- The magnitude of reductions in life expectancy associated with (largely untreated) hypertension is undoubtedly lower in the current era of effective therapies for hypercholesterolemia and diabetes. Tobacco use today is a fraction of those noted.
-Nonetheless, the article illustrates the natural history of disease in essentially untreated hypertensives; importantly even pre-hypertension is associated with reductions in life expectancy.