Trials of antihypertensive treatment—new agenda for the millennium

In 1968 a group of investigators from the US Veterans Association study reported that, compared to placebo, antihypertensive medication dramatically reduces morbidity and mortality in patients whose diastolic blood pressure was 115 mm Hg or higher. Three years later a reduction of morbidity had also been demonstrated in subjects whose diastolic pressure ranged from 95 to 114 mm Hg. In the following decades these findings were confirmed in numerous investigations of various populations. We now know that antihypertensive treatment is beneficial in mild hypertension, in isolated systolic hypertension, and in hypertension of the elderly. When it comes to the treatment of mild hypertension we will have to practice evidenceless medicine and act on the internal logic of the issue. The logic suggests that many present-day antihypertensive agents are harmless, that over the long term they may prevent target organ damage, that early intervention may be more beneficial than late treatment, and, finally, that treating mild hypertension may have a major positive impact on public health.