The best of hypertension in 2000

Three subjects or themes were estimated significant in the year 2000. The study published by Fagard et al. on nonsustained isolated systolic hype rtension (or white coat hypertension) The authors showed, in a spin-off study of SYST-EUR, that 24% of subjects w ith isolated systolic hyper-tension on conventional measurement were not hy pertensive during ambulatory blood pressure monitoring. Moreover, in white coat hypertension, treatment had no effect either on the electrical signs o f left ventricular hypertrophy or on the incidence of clinical events (cere brovascular accident and global cardiovascular complications), contrary to what is observed in permanent systolic hypertension. These results raise qu estion as to the diagnosis and treatment of isolated systolic hypertension in the elderly and prompt to a larger usage (if not systematic) of ambulato ry blood pressure monitoring in this context. The importance of systolic blood pressure and pulsed pressure For different reasons, diastolic blood pressure was thought to be of greate r prognostic significance, as the very large majority of clinical trials re cruited on the basis of the value of their diastolic blood pressure alone d emonstrate. In recent years, the importance of systolic blood pressure has been underlined in many studies and 3 trials have shown the unquestionable benefits of treatment of isolated hypertension. It would also appear that t he pulse pressure, which reflects arterial compliance, has considerable pro gnostic value. In the absence of established manometric criteria and mostly of therapeutic trials, the practical use of the pulse pressure remains que stionable. The interruption of the doxazosine arm of the ALLHAT trial The ALLHAT (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) study showed a doubling of the morbidity from cardiac failure , a 19% excess of cerebrovascular events and 16% of angina pectoris in subj ects treated with doxazosin compared with those treated with chlortalidone. The differences in blood pressure with treatment were minimal and, a prior i, unable to explain these results. Beyond the fact that alphablockers cann ot be considered as first-line antihypertensive therapy, without doubt, the affirmation that lowering the blood pressure provides the same benefit irr espective of the antihypertensive agent used, probably needs to be reviewed .