Skip to main content
SpringerLink
Log in

Hypertension

Treatment and Outcomes

  • Interventions & Outcomes
  • Published:
Disease Management & Health Outcomes

Summary

The prevalence of cardiovascular morbidity and mortality can be decreased by artificially lowering arterial blood pressure (BP), even in asymptomatic individuals. However, the actual impact of such intervention has not been as great as that predicted from epidemiological studies.

The earlier estimates of benefit from reducing BP have concerned reductions in diastolic BP, with the effect of reductions in systolic BP, and in particular interventions for isolated systolic hypertension, being less well investigated. Moreover, the advent of oscillometric BP recording, ambulatory BP monitoring and home-based self-assessment, and the phasing out of mercury sphygmomanometers, will all require a number of assumptions to be made about the equivalence of historical BP data with values measured by different, newer techniques.

A number of studies using newer antihypertensive agents or aimed at specific therapeutic questions are under way or planned. These are summarised in this review. Although the traditional and most straightforward assessment of response to treatment is by regular auscultatory sphygmomanometric assessment of brachial BP, the availability of more advanced techniques should be factored into studies and may prove useful in clinical routine.

Any reduction in either diastolic or systolic BP is beneficial to vascular health. Therefore, interventions that are known to reduce BP should be encouraged in all hypertensive patients. Pharmacological intervention should commence when nonpharmacological treatment has not achieved target BP. Delay must be avoided in ‘high risk’ patients in whom early therapy is indicated. Other cardiovascular risk factors should be attended to, especially cigarette smoking.

The results of the Treatment of Mild Hypertension Study suggest that most antihypertensive agents achieve comparable results in lowering BP. Therefore, drug choice can be made on the basis of avoidance of adverse effects or other benefits, provided that outcomes data on mortality and morbidity are available for the drug being considered. If the target BP is not achieved by the first choice drug, a second drug should be added.

Elevated BP is only one modifiable cardiovascular risk factor and should not be treated in isolation; concurrent treatment of hyperglycaemia and dyslipidaemias should be actively pursued.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease: part 1. Prolonged differences in blood pressure: prospective observational studies corrected for regression dilution bias. Lancet 1990; 335: 765–74

    CAS  Google Scholar 

  2. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease: part 2. Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335: 827–38

    CAS  Google Scholar 

  3. Krakoff LR. Management of the hypertensive patient. New York: Churchill Livingston, 1995

    Google Scholar 

  4. Staessen JA, Bulpitt CJ, Fagard R, et al. The influence of menopause on blood pressure. In: Safar ME, Stimpel M, Zanchetti A, editors. Berlin: Springer-Verlag, 1994

  5. Hansson L, for the HOT study group. The Hypertension Optimal Treatment Study (the HOT Study). Blood Press 1993; 2: 62–8

    Article  Google Scholar 

  6. Bulpitt CJ. A risk-benefit analysis for the treatment of hypertension. Postgrad Med J 1993; 69: 764–74

    Article  PubMed  CAS  Google Scholar 

  7. Hansson L. The benefits of lowering elevated blood pressure: a critical review of studies of cardiovascular morbidity and mortality in hypertension. J Hypertens 1996; 14: 537–44

    Article  PubMed  CAS  Google Scholar 

  8. MacMahon S, Cutler JA, Stamler J. Antihypertensive drug treatment: potential, expected and observed effects on stroke and coronary heart disease. Hypertension 1989; 13 Suppl. I: 145–50

    Google Scholar 

  9. Neutal JM, Smith DHG, Graettinger WF, et al. Dependency of arterial compliance on circulating neuroendocrine and metabolic factors in normal subjects. Am J Cardiol 1992; 69: 1340–4

    Article  Google Scholar 

  10. Dzau VJ, Safar ME. Large conduit arteries in hypertension: role of the vascular renin-angiotensin system. Circulation 1988; 77: 947–54

    Article  PubMed  CAS  Google Scholar 

  11. Cameron JD, Dart AM. Exercise training increases total systemic arterial compliance in humans. Am J Physiol 1994; 266: H693–H701

    PubMed  CAS  Google Scholar 

  12. Rajkumar C, Mehra R, Kingwell BA, et al. Hormone replacement therapy is associated with increased systemic arterial compliance in post-menopausal women [abstract]. Circulation 1996; 94 (8 Suppl.): I151

    Google Scholar 

  13. Dart A, Silagy C, Dewar E, et al. Aortic distensibility and left ventricular structure and function in isolated systolic hypertension. Eur Heart J 1993; 14: 1465–70

    Article  PubMed  CAS  Google Scholar 

  14. Cruickshank JM. The role of coronary perfusion pressure. Eur Heart J 1992; 13 Suppl. D: 39–43

    Article  PubMed  Google Scholar 

  15. Witteman JCM, Grobbee DE, Valkenburg HA, et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet 1994; 343: 504–7

    Article  PubMed  CAS  Google Scholar 

  16. Staessen J, Bulpitt CJ, Clement D, et al. Relation between mortality and treated blood pressure in elderly patients with hypertension: report of the European Working Party on High Blood Pressure in the Elderly. BMJ 1989; 298: 1552–6

    Article  PubMed  CAS  Google Scholar 

  17. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older patients with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255–64

    Article  Google Scholar 

  18. O’Rourke MF. Arterial stiffness, systolic blood pressure and the logical treatment of arterial hypertension. Hypertension 1990; 15: 339–47

    Article  PubMed  Google Scholar 

  19. Dzau VJ. Significance of vascular renin-angiotensin pathways. Hypertension 1986; 8: 553–9

    Article  PubMed  CAS  Google Scholar 

  20. Safar ME, Levy BI, Laurent S, et al. Hypertension and the arterial system: clinical and therapeutic aspects. J Hypertens 1990; 8 Suppl. 7: S113–9

    CAS  Google Scholar 

  21. Safar ME. Arteries in clinical practice. Philadelphia: LippincottRaven, 1996

    Google Scholar 

  22. Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322: 1561–6

    Article  PubMed  CAS  Google Scholar 

  23. Dahlof B, Pennert K, Hansson L. Regression of left ventricular hypertrophy: a meta-analysis. Clin Exp Hypertens A 1992; 14: 173–80

    Article  PubMed  CAS  Google Scholar 

  24. Medical Research Council Working Party. Medical Research Council Trial of Treatment of Mild Hypertension: principal results. BMJ 1985; 291: 97–104

    Article  Google Scholar 

  25. Jennings GL, Nelson L, Nestel P, et al. The effects of changes in physical activity on major cardiovascular risk factors, haemodynamics, sympathetic function, and glucose utilization in man: a controlled study of four levels of activity. Circulation 1986; 73: 30–40

    Article  PubMed  CAS  Google Scholar 

  26. Kingwell BA, Cameron JD, Gillies KJ, et al. Arterial compliance as a determinant of baroreflex function in athletes and hypertensives. Am J Physiol 1995; 268: H411–8

    PubMed  CAS  Google Scholar 

  27. Mohiaddin RH, Underwood SR, Bogrin HG, et al. Regional aortic compliance study by magnetic resonance imaging: the effects of age, training and coronary artery disease. Br Heart J 1989; 62: 90–6

    Article  PubMed  CAS  Google Scholar 

  28. Kupari M, Hekali P, Keto P, et al. Relation of aortic stiffness to factors modifying the risk of atherosclerosis in healthy people. Arterioscler Thromb 1994; 14: 386–94

    Article  PubMed  CAS  Google Scholar 

  29. Kannel WB, Gordon T, Schwartz MJ. Systolic versus diastolic blood pressure and risk of coronary heart disease: the Framingham study. Am J Cardiol 1971; 27: 335–46

    Article  PubMed  CAS  Google Scholar 

  30. Bulpitt CJ. Hypertension in the very elderly. J Hum Hypertens 1994; 8: 603–5

    PubMed  CAS  Google Scholar 

  31. Slovick DI, Fletcher AE, Daymond M, et al. Quality of life and cognitive function on a diuretic compared with a beta blocker: a randomised controlled trial of bendrofluazide versus dilevalol in elderly hypertensive patients. Cardiol Elderly 1995; 3: 139–45

    Google Scholar 

  32. Amery A, Birkenhager A, Brixko R, et al. Efficacy of antihypertensive drug treatment according to age, sex, blood pressure and previous cardiovascular disease in patients over the age of 60. Lancet 1986; II: 589–92

    Article  Google Scholar 

  33. Medical Research Council Working Party. Medical Research Council Trial of Treatment in Older Adults: principal results. BMJ 1992; 304: 405–12

    Article  Google Scholar 

  34. Dahlof B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 338: 1281–5

    Article  PubMed  CAS  Google Scholar 

  35. Amery A, Birkenhager W, Bulpitt CJ, et al. SYST-EUR: a multicentre trial on the treatment of isolated systolic hypertension in the elderly: objectives, protocol and organisation. Aging Clin Exp Res 1991; 3: 287–302

    CAS  Google Scholar 

  36. Systolic Hypertension in the Elderly’s Collaborative Group Coordinating Centre. Systolic hypertension in the elderly: Chinese trial (SYST-CHINA) — interim report. Chinese J Cardiol 1992; 20: 270–5

    Google Scholar 

  37. Dahlof B, Hansson L, Lindholm LH, et al. STOP-Hypertension-2: a prospective intervention trial of ‘newer’ versus ‘older’ treatment alternatives in old patients with hypertension. Blood Press 1993; 2: 136–41

    Article  PubMed  CAS  Google Scholar 

  38. Bulpitt CJ, Fletcher AE, Amery A, et al. The Hypertension in the Very Elderly Trial (HYVET): rationale, methodology and comparison with previous trials. Drugs Aging 1994; 5(3): 171–83

    Article  PubMed  CAS  Google Scholar 

  39. Davis BR, Cutler JA, Gordon DJ, et al. Rationale and design for the antihypertensive and lipid lowering treatment to prevent heart attack trial (ALLHAT). Am J Hypertens 1996; 9 (4 Pt 1): 342–60

    Article  PubMed  CAS  Google Scholar 

  40. Kjeldsen SE, Omvik P. Losartan and the LIFE-Study: antihypertensive treatment with ATI-receptor antagonist. Tidsskr Nor Laegeforen 1996; 116(4): 504–7

    PubMed  CAS  Google Scholar 

  41. NORDIL study group. The Nordic diltiazem study: an intervention study in hypertension comparing calcium antagonist based treatment with conventional therapy. Blood Press 1993; 2: 312–21

    Article  Google Scholar 

  42. Neal B, MacMahon S, on behalf of the PROGRESS Management Committee. The PROGRESS Study: rationale and design. J Hypertens 1995; 13: 1869–73

    Article  PubMed  CAS  Google Scholar 

  43. The Hypertension in Diabetes Study Group. Hypertension in Diabetes Study (HDS): II. Increased risk of cardiovascular complications in hypertensive type 2 diabetic patients. J Hypertens 1993; 11: 319–25

    Article  Google Scholar 

  44. Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986; 314: 1657–64

    Article  PubMed  CAS  Google Scholar 

  45. Steiner SS, Friedhoff AJ, Wilson BL, et al. Antihypertensive therapy and quality of life: a comparison of atenolol, captopril, enalapril and propranolol. J Hum Hypertens 1990; 4: 217–25

    PubMed  CAS  Google Scholar 

  46. Fletcher AE, Chester PC, Hawkins CMA, et al. The effects of verapamil and propranolol on quality of life in hypertension. J Hum Hypertens 1989; 3: 125–30

    PubMed  CAS  Google Scholar 

  47. Palmer AJ, Fletcher AE, Rudge PJ, et al. Quality of life in hypertensives treated with atenolol or captopril: a double-blind crossover trial. J Hypertens 1992; 10: 1409–16

    Article  PubMed  CAS  Google Scholar 

  48. The Treatment of Mild Hypertension Research Group. The treatment of mild hypertension study: a randomised, placebocontrolled trial of a nutritional-hygenic regimen along with various drug monotherapies. Arch Intern Med 1991; 151: 1413–23

    Article  Google Scholar 

  49. Neaton JD, Grimm RH, Prineas RJ, et al. (Treatment of Mild Hypertension Study Research Group). Treatment of Mild Hypertension Study: final results. JAMA 1993; 270(6): 713–24

    CAS  Google Scholar 

  50. Materson BJ, Reda DJ, Cushman WC, et al. Single-drug therapy for hypertension in men: a comparison of six antihypertensive agents with placebo. N Engl J Med 1993; 328: 914–21

    Article  PubMed  CAS  Google Scholar 

  51. Bulpitt CJ, Fletcher AE. Quality of life evaluation of antihypertensive drugs. Pharmacoeconomics 1992; 2: 95–102

    Article  Google Scholar 

  52. Testa MA, Anderson RB, Nackley JF, et al. Quality of life and antihypertensive therapy in men: a comparison of captopril with enalapril. N Engl J Med 1993; 328: 907–13

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Biomedical Engineering, School of Electronic Engineering, La Trobe University, Melbourne, Victoria, Australia

    James D. Cameron

  2. Division of Geriatric Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London, W12 0NN, England

    Christopher J. Bulpitt

Authors
  1. James D. Cameron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher J. Bulpitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

About the Authors: Dr James D. Cameron is Senior Lecturer in Biomedical Engineering at La Trobe University, Melbourne and Senior Clinical Associate at the Baker Medical Research Institute. His current research interests include noninvasive assessment of vascular mechanical properties and cardiovascular risk assessment and treatment. Professor Christopher J. Bulpitt is Professor of Geriatric Medicine at the Royal Postgraduate Medical School (RPMS), Hammersmith Hospital, London, and Honorary Consultant Physician in Geriatric and General Internal Medicine. His previous posts include Reader in Pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, Reader in Epidemiology at the RPMS and Honorary Senior Lecturer in Clinical Pharmacology at the RPMS. His research interests include hypertension, especially in the elderly; screening in the elderly; vascular compliance; and the measurement of biological age.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cameron, J.D., Bulpitt, C.J. Hypertension. Dis-Manage-Health-Outcomes 2, 8–21 (1997). https://doi.org/10.2165/00115677-199702010-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-199702010-00002

Keywords

Search

Navigation