Agreement: I Agree Body: Dear Editor In the specific context of antihypertensive medication there is an important caveat that is relevant to the use of polypills that incorporate a diuretic, such as the polypill utilised in the International Polycap Study-3(TIPS-3).. Each polypill included a thiazide diuretic as one of its ingredients[1]. The caveat is that, during a heat wave, when there is high risk of dehydration, that risk is compounded by continuing administration of a diuretic. This might have been the case during the recent heat wave, when Dr Hillary Williams reported that "There are reports of older patients arriving at hospital having collapsed or with dehydration.". She added "As clinicians there are immediate steps we can take to protect patients, such as reviewing medications that affect hydration...."[2] The obvious strategy of exclusive omission of the diuretic component of antihypertensive medication is not possible when antihypertensive medication is administered as a polypill References [1]Joseph P., Pais P., Lans A et al The international polycap study-3(TIPS-3) Design, baseline characteristics and challenges in conduct Am Heart J 2018;206:72-79 [2]Andrew Gregory Hospitals in England declare critical incidents as machiones and IT fail in heat Guardian 25 Jube 2026 H No competing Interests: Yes The following competing Interests: Electronic Publication Date: Saturday, July 25, 2026 - 18:56 AI use: No, I have not used AI Highwire Comment Subject: Long term benefits of blood pressure lowering . . . and other research Workflow State: Released Full Title: Re: Long term benefits of blood pressure lowering . . . and other research Highwire Comment Response to: Long term benefits of blood pressure lowering . . . and other research Check this box if you would like your letter to appear anonymously:: Last Name: Jolobe First name and middle initial: oscar,m Email: oscarjolobe@yahoo.co.uk Address: Clothorn Road Occupation: retired geriatrician Affiliation: British Medical Association BMJ: Additional Article Info: Rapid response