• Blood pressure
• hypertension
• left ventricular hypertrophy

The Authors' reply: We thank David Wald for his comment.1 The meta analysis by Law et al (2009) does indeed make a good case for blood pressure reduction among individuals with average or low blood pressures at baseline.2 However, balanced against that are some large randomised trials like HOT, CAMELOT and ONTARGET where extra blood pressure reduction did not produce a convincing benefit. The above-mixed picture is why no guidelines yet specifically advocate reducing blood pressure further in those with normal or low blood pressures at baseline. That is why we used our study to advocate further work is undertaken to investigate this strategy as we feel it is likely to turn out to be beneficial once such work is done. We do, however, feel that the case needs more underpinning data and especially more data on its overall cost effectiveness.

In fact, in our paper, we were suggesting that this strategy of extra blood pressure reduction is investigated particularly in those normotensives with target organ damage, that is left ventricular hypertrophy (LVH). It is likely to be more cost effective in normotensives with LVH than in normotensives without LVH, as the former have a higher incidence of future CV events than the latter.