Hypertension, quantitative benefits of treatment: optimal intervention points and management in aircrew

The risks associated with arterial hypertension, and particularly increased cardiovascular, cerebral fatal and non-fatal events are well established, as are those with end-stage renal disease. The incidence of stroke and, to a lesser extent, of fatal and non-fatal coronary events, is significantly r educed by lowering high blood pressure, as demonstrated in previous studies . The relative benefit of therapy is fairly uniform in most intervention tr ials, independent of severity of hypertension and of patient age. However, the absolute benefit varies between the different trials and is much greate r in severe hypertensive and/or elderly patients, in whom the absolute risk of cardiovascular events is also higher. Antihypertensive treatment is mor e cost-effective in high-risk patients than in those without complications in the short term. In young and middle-aged patients with mild hypertension , earlier treatment, though less cost-effective, is likely to be more effec tive in the prevention of end organ damage development, and the reduction o f subsequent morbid events in the long term. This should help subjects achi eve their full life-span. Possible strategies to improve the benefit of ant ihypertensive treatment have been recently investigated by appropriate tria ls and it has been suggested that the use of cardiovascular drugs which hav e tissue-protective properties may have an additional benefit similar to th at achieved by lowering the blood pressure.