Hypertension and Diabetes

In recent years, the British Medical Journal published several papers apropos the “parachute approach evidencebased medicine” (1). In the original profound article, Smith and Pell argued that the parachute use to prevent death and major trauma due to capital challenge is clearly obvious, and there is no need for randomized controlled trials (2). Although this argument may hold true in medicine for only few situations, waiting for the results of randomized end point trials of therapeutic interventions can cost hundred of lives under certain circumstances. If the science is good, we should act before trials are performed using intermediate end points or “surrogates” as therapeutic targets. Indeed, surrogate parameters have emerged as most helpful tools for an evidence-based approach for therapeutic decisions in cardiovascular medicine. The ensuing article outlines the pro arguments that surrogates are most acceptable targets for treating patients with hypertension and diabetes.