Cardiovascular outcomes of treating high blood pressure.

Because hypertension is a major risk factor for cardiovascular disease, it has been anticipated that therapeutic reduction of blood pressure would protect patients from serious complications. In fact, this has been shown for strokes, congestive heart failure, and renal insufficiency. But in large trials of hypertension treatment, patients receiving active medications experienced an incidence of coronary events that averaged only 7% lower than that in placebo-treated patients. This report examines some of the reasons for this disappointing outcome. During therapeutic trials patients receiving placebo tended to have fewer cardiovascular events than predicted. However, patients on active therapy in large-scale studies may have suboptimal blood pressure control. They may also be exposed to the adverse effects of inappropriate therapy. Careful selection of modern drugs should allow blood pressure to be controlled in a safe manner, and possibly contribute directly to protection from coronary events and other cardiovascular complications.