Blood pressure and cardiovascular disease: what remains to be achieved?

Despite dramatic improvements in the management of hypertensive cardiovascu lar disease, much remains to be accomplished. Arterial stiffness, through i ts effects on central aortic pressure, is a key determinant of increased ca rdiovascular risk. Increased pulse pressure is a late manifestation of incr eased arterial stiffness. What is needed is a simple, reliable, non-invasiv e method of detecting early disturbances in central artery stiffness at a t ime when therapeutic intervention can be most beneficial. Currently, interv ention studies support initiating antihypertensive therapy in uncomplicated hypertension when systolic blood pressure greater than or equal to 160 mmH g, whereas the benefit of treating systolic blood pressure of 140-159 mmHg, the largest subset of persons with hypertension, has yet to be tested in c ontrolled trials. Further studies are needed to determine the optimal targe t goal for blood pressure reduction in both uncomplicated hypertension and in hypertension complicated by diabetes, coronary heart disease, or renal d isease. Angiotensin converting enzyme inhibitors may provide selective card iac and renal protection beyond their blood pressure-lowering effect in the presence of specific cardiovascular disease and/or diabetes. In contrast, there is as yet no definitive answer as to the relative benefit of blood pr essure lowering versus specific drug effects in minimizing cardiovascular e vents in uncomplicated hypertension. Although there has been a recent incre ase in hypertension awareness and treatment, only a small percentage of aff ected individuals are being treated to goal. Hypertensive cardiovascular di sease represents a world-wide public health challenge that can be solved on ly by new innovative measures aimed at both prevention and treatment. J Hyp ertens 19 (suppl 3):S3-S8 (C) 2001 Lippincott Williams & Wilkins.