Current antihypertensive treatment: Can we do better?

Results of various randomized, controlled clinical trials have shown that a ntihypertensive treatment is accompanied by reductions in morbidity and mor tality caused by cardiovascular, cerebrovascular, and renal disease. Treatm ent confers a protective benefit against stroke, coronary artery disease, a nd heart failure, as well as against conditions previously considered unrel ated to elevated blood pressure (eg, loss of cognitive function and dementi a). Overall benefits of antihypertensive treatment are probably even greate r than those shown in clinical trials. More rigorous blood pressure control in high-risk and multiple-risk patients provides even greater benefits. Be cause epidemiologic findings indicate that elevated systolic blood pressure (SBP) may be a greater risk factor for cardiovascular disease than elevate d diastolic blood pressure (DBP), more attention should be paid to the cont rol of SEP. Pulse pressure may be a better indicator of target-organ damage than either SEP or DBP, but further evaluation of its prognostic value is required. New monotherapies that can significantly reduce blood pressure, e specially SEP, and confer protection on the target organs most affected by chronic hypertension may substantially add to current treatment. Am J Hyper tens 1999;12:131S-138S (C) 1999 American Journal of Hypertension, Ltd.