Summary
The large multicenter trials of treatment in mild to moderate hypertension have shown unequivocally that the risk of stroke is reversed. The impact of treatment on ischemic heart disease is more debatable. Since there is no discontinuity in the risk of different levels of blood pressure, any advice about the level of pressure to treat must be arbitrary. The British Hypertension Society Guidelines recommend a sustained diastolic pressure of 100 mmHg or more over a 3- to 4-month period. This empirical advice is based upon subgroup analysis of the MRC and Australian Therapeutic Trials that suggests most of the benefit in treating the mildest degrees of hypertension occur in this group of patients. The role of newer classes of agent, such as ACE inhibitors or calcium-channel blockers, cannot be fully assessed in the absence of proper end-point trials. Whilst reasons for using these agents as first-line therapy have been put forward, these remain speculative in the absence of such trials. The much greater cost of newer agents in the context of universally cost-constrained health services also has to be horne in mind before recommending their widespread use as first-line therapy.
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References
Bing RF, Heagerty AM, Russell GI, et al. Prognosis in malignant hypertension. J Hypertens 1986;4(Suppl 6): S42-S44.
Amery A, Birkenhager W, Brixko P, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial. Lancet 1985;1:1349–1354.
Stamler J, Neaton JD, Wentworth DN. Blood pressure (systolic and diastolic) and risk of fatal coronary heart disease. Hypertension 1989; 13(Suppl 1):1–2–1–12.
Coroni-Huntley J, LaCroix AZ, Havlik RJ. Race and sex differentials in the impact of hypertension in the United States: The National Health and Nutrition Examination Survey. 1. Epidemiologic follow-up study. Arch Intern Med 1989;149:780–788.
Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke and coronary heart disease. Part II. Short term reductions in blood pressure: Overview of randomized drug trials in their epidemiological context. Lancet 1990;335: 827–838.
Hypertension Detection and Follow-up Programme Co-operative Group. The Hypertension, Detection and Follow-Up Programme: Progress report: Circ Res 1977;40(Suppl 1):107–109.
Medical Research Council Working Party. MRC trial of treatment of mild hypertension: Principal results. Br Med J 1985;291:97–104.
Weinstein MC, Stason WB, Hypertension—A Policy Perspective. Cambridge, MA. Harvard University Press, 1976.
Kawachi I, Malcolm LA. The cost effectiveness of treating mild to moderate hypertension: A reappraisal. J Hypertens 1991;9:199–208.
Swales JD. First line treatment in hypertension. Br Med J (1991);301:1172–1173.
Swales JD. Practice in medicine under financial constraints: The future. In: L'Etang H, ed. Health Care and provision under financial constraint: A decade of change. International Congress and Symposium Series. London: Royal Society of Medicine, 1990:199–207.
Amery A. Anlauf A, Beilin LJ, et al. Guidelines for the treatment of mild hypertension: Memorandum from WHO/ISH meeting. J Hypertens 1986;4:383–386.
Joint National Committee. The 1988 report of Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med 1988;148:1023–1038.
British Hypertension Society Working Party. Treating mild hypertension: Agreement from the large trials. Br Med J 1989;298:694–698.
Reader R, Bauer GE, Doyle AE, et al. The Australian Therapeutic Trial on Mild Hypertension: Report by the management committee. Lancet 1980;1:1261–1267.
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Swales, J.D. The level at which blood pressure should be treated. Cardiovasc Drug Ther 5, 979–981 (1991). https://doi.org/10.1007/BF00143523
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DOI: https://doi.org/10.1007/BF00143523