Abstract: To the Editor: We thank Dr. Huai Yong Cheng for his interest in our study “Association between blood pressure and survival over 9 years in a general population aged 85 and older.” Dr. Cheng brings up an important matter: the treatment of hypertension in the oldest old. As Dr. Cheng points out, evidence is sparse because the clinical trials that have included the very old are lacking. Our population-based epidemiological study showed that low systolic blood pressure was independently associated with high risk of death after adjusting for multiple confounders. In his comment, Dr. Cheng questions the possible confounding effect of the antihypertensive treatment. We analyzed the possible association between blood pressure (BP)-lowering drugs (beta-blockers, diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors) and mortality. Almost half of the subjects (n=269, 47.3%) were using BP-lowering medication for some indication (hypertension, heart failure, etc.), but their use was not associated with mortality (hazard ratio=1.16, 95% confidence interval=0.92–1.45). The inclusion of BP-lowering medication in the multivariate model did not change the results. Nevertheless, our study was an epidemiological study, and only controlled clinical trials will give reliable information about the treatment of hypertension in this age group. Financial Disclosure: Sari Rastas: Ministry of Education in Finland, the 100th Anniversary Foundation of Helsingin Sanomat, the Alzheimer Foundation of Finland, Finnish Neurology Association, the Red Feather Project of Lions, the Uulo Arhio Foundation. Author Contributions: Sari Rastas, Tuula Pirttilä, Kimmo Mattila, and Esko Länsimies: study concept and design, and preparation of the manuscript. Petteri Viramo and Kati Juva: preparation of the manuscript. Auli Verkkoniemi: study concept and design, and acquisition of subjects. Pirjo Halonen: analysis and interpretation of data. Leena Niinistö and Raimo Sulkava: study concept and design. Sponsor's Role: None.