Cardiovascular risks of hypertension: lessons from observational studies

Hypertension is an acknowledged major risk factor for cardiovascular diseas e and death in both men and women. Despite a historical focus by clinicians on the importance of diastolic blood pressure (DBP) risks, epidemiologic d ata from numerous large-scale studies have clearly demonstrated that both s ystolic blood pressure (SBP) and DBP are important determinants of cardiova scular risk. Recent analyses have described notable risks associated with i solated and borderline elevations of SEP, which predominate in the elderly, emphasizing the independent contribution of elevated SEP in determining ov erall risk. Overviews of large-scale treatment trials show that antihyperte nsive drug treatment confers a favorable net clinical benefit in patients w ith diastolic and isolated systolic hypertension, and the magnitude of risk reduction is comparable to that expected from the observational data. Howe ver, at any level of SEP or DBP, the absolute magnitude of risk varies wide ly depending on the burden of coexisting risk factors present. Therefore, i t is essential that decisions regarding the urgency, risks and benefits of antihypertensive drug treatments be informed by accurate determinations of overall cardiovascular risk (C) 1998 Lippincott Williams & Wilkins.