Implications of the main therapeutic trials conducted in hypertension.

An impressive number of patients has been followed in intervention trials, some of them carefully designed and executed. The different intervention trials in hypertensives are compatible with the hypothesis that hypotensive drug treatment can decrease cardiovascular mortality mainly by decreasing cerebrovascular mortality. A decrease in fatal and non-fatal cardiovascular event rate is mainly due to the decrease in cerebrovascular events. On the basis of these trials the expert committee of the WHO and ISH recommend first general hygienic measures. When the blood pressure remains above 100 mm Hg after 3 months or above 95 mm Hg after 6 months follow-up, hypotensive drugs should be considered. It is not established whether the hypotensive drug treatment is advisable in: --symptomless patients with isolated systolic hypertension, --hypertensive patients above age 80. Sudden reduction in blood pressure should be avoided but whether a progressive reduction of the systolic blood pressure below 140 mm Hg and a diastolic blood pressure below 85 mm Hg is dangerous or advantageous remains to be established.