Treatment of Mild Hypertension and the Reduction of Cardiovascular Mortality: The `Of or By' Dilemma

Abstract

Two years ago, when the findings of the Hypertension Detection and Follow-up Program (HDFP) trial of the treatment of patients with mild hypertension were first published,¹it seemed clear to many persons that there should be no more "benign neglect" in the treatment of such patients whose mortality could be reduced by almost 20% with medication. The HDFP was one of a series of several similar trials, which together present some interesting parallels with the recent secondary prevention trials of β-blockers after myocardial infarction. In both situations, pharmacotherapy is moving from the defensive (relief of symptoms) to the offensive (prevention of morbidity in symptomless persons), and, in both situations, the decision to start a particular individual on treatment depends on a careful weighing of statistical probabilities. Although recommendations have been made for treating all patients who are potentially at risk, there are reasons for taking a more cautious viewpoint,