602
JACC VOL. 67, NO. 5, 2016
Letters
FEBRUARY 9, 2016:596–602
in the expected clinical outcome, just like other
medicine is defined as “treatments targeted to
clinical factors.
the needs of individual patients on the basis of
When all of these factors are evaluated for the in-
genetic,
biomarker,
phenotypic,
or
psychosocial
dividual (including miRNAs), they may come close to
characteristics
being accurate for that person. However, as far as I
from
can tell, prognostication of outcome is easily deter-
sentations” (2). The HIPARCO score (1,3), based
mined for populations, but prognostication of an
on epigenetics analysis, is able to distinguish “a given
other
that
distinguish
patients
with
a
given
similar
patient
clinical
pre-
individual’s response to therapy is an educated guess.
patient from other patients with similar clinical pre-
I am all for being as precise and accurate as
sentations.” The results of our study show that if a
possible when making decisions about individual
patient obtains a HIPARCO score of 0 or 6, the prob-
patients. Unfortunately, so far, clinical decisions are
ability of making the appropriate clinical decision is
not as precise and accurate as one would like.
higher
If medicine ever becomes “precise and accurate,”
than
94%.
This
instrument
could
help
physicians make precise and accurate decisions.
there will be no need for judgment by physicians. In
Medicine was originally an art, and the generation
fact, there may not be any need for physicians. In my
of knowledge over time made it a science. Medical
opinion, clinical judgment is still necessary to make
practice must become as precise and accurate as
clinical decisions in the individual patient, and it will
possible, and it is the primary role of research to lead
stay that way for a long time.
the way toward this milestone.
*Richard Conti, MD *Cardiology
Manuel Sánchez-de-la-Torre, PhD *Ferran Barbé, MD
University of Florida
*Respiratory Department, IRB Lleida. CIBERES
1600 SW Archer Road
Hospital Universitari Arnau de Vilanova Rovira Roure, 80
Gainesville, Florida 32610
25198 Lleida
E-mail: [email protected]fl.edu
Spain
http://dx.doi.org/10.1016/j.jacc.2015.09.111
E-mail: [email protected]
Please note: Dr. Conti has reported that he has no relationships relevant to the contents of this paper to disclose.
http://dx.doi.org/10.1016/j.jacc.2015.10.088 Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
REFERENCE 1. Sánchez-de-la-Torre M, Khalyfa A, Sánchez-de-la-Torre A, et al. Precision medicine in patients with resistant hypertension and obstructive sleep apnea: blood pressure response to continuous positive airway pressure treatment. J Am Coll Cardiol 2015;66:1023–32.
REPLY: Precision Medicine, Obstructive Sleep Apnea, and Refractory Hypertension We appreciate Dr. Conti’s comments regarding our study (1) and share his thoughts. However, precision
REFERENCES 1. Sánchez-de-la-Torre M, Khalyfa A, Sánchez-de-la-Torre A, et al. Precision medicine in patients with resistant hypertension and obstructive sleep apnea. J Am Coll Cardiol 2015;66:1023–32. 2. Jameson JL, Longo DL. Precision medicine–personalized, problematic, and promising. N Engl J Med 2015;372:2229–34. 3. Martínez-García MA, Capote F, Campos-Rodriguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA 2013;310: 2407–15.
JACC VOL. 67, NO. 5, 2016
Letters
FEBRUARY 9, 2016:596–602
in the expected clinical outcome, just like other
medicine is defined as “treatments targeted to
clinical factors.
the needs of individual patients on the basis of
When all of these factors are evaluated for the in-
genetic,
biomarker,
phenotypic,
or
psychosocial
dividual (including miRNAs), they may come close to
characteristics
being accurate for that person. However, as far as I
from
can tell, prognostication of outcome is easily deter-
sentations” (2). The HIPARCO score (1,3), based
mined for populations, but prognostication of an
on epigenetics analysis, is able to distinguish “a given
other
that
distinguish
patients
with
a
given
similar
patient
clinical
pre-
individual’s response to therapy is an educated guess.
patient from other patients with similar clinical pre-
I am all for being as precise and accurate as
sentations.” The results of our study show that if a
possible when making decisions about individual
patient obtains a HIPARCO score of 0 or 6, the prob-
patients. Unfortunately, so far, clinical decisions are
ability of making the appropriate clinical decision is
not as precise and accurate as one would like.
higher
If medicine ever becomes “precise and accurate,”
than
94%.
This
instrument
could
help
physicians make precise and accurate decisions.
there will be no need for judgment by physicians. In
Medicine was originally an art, and the generation
fact, there may not be any need for physicians. In my
of knowledge over time made it a science. Medical
opinion, clinical judgment is still necessary to make
practice must become as precise and accurate as
clinical decisions in the individual patient, and it will
possible, and it is the primary role of research to lead
stay that way for a long time.
the way toward this milestone.
*Richard Conti, MD *Cardiology
Manuel Sánchez-de-la-Torre, PhD *Ferran Barbé, MD
University of Florida
*Respiratory Department, IRB Lleida. CIBERES
1600 SW Archer Road
Hospital Universitari Arnau de Vilanova Rovira Roure, 80
Gainesville, Florida 32610
25198 Lleida
E-mail: [email protected]fl.edu
Spain
http://dx.doi.org/10.1016/j.jacc.2015.09.111
E-mail: [email protected]
Please note: Dr. Conti has reported that he has no relationships relevant to the contents of this paper to disclose.
http://dx.doi.org/10.1016/j.jacc.2015.10.088 Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
REFERENCE 1. Sánchez-de-la-Torre M, Khalyfa A, Sánchez-de-la-Torre A, et al. Precision medicine in patients with resistant hypertension and obstructive sleep apnea: blood pressure response to continuous positive airway pressure treatment. J Am Coll Cardiol 2015;66:1023–32.
REPLY: Precision Medicine, Obstructive Sleep Apnea, and Refractory Hypertension We appreciate Dr. Conti’s comments regarding our study (1) and share his thoughts. However, precision
REFERENCES 1. Sánchez-de-la-Torre M, Khalyfa A, Sánchez-de-la-Torre A, et al. Precision medicine in patients with resistant hypertension and obstructive sleep apnea. J Am Coll Cardiol 2015;66:1023–32. 2. Jameson JL, Longo DL. Precision medicine–personalized, problematic, and promising. N Engl J Med 2015;372:2229–34. 3. Martínez-García MA, Capote F, Campos-Rodriguez F, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA 2013;310: 2407–15.
