Results of the multicenter antihypertensive treatment trials. Therapeutic implications and the role of the sympathetic nervous system.
The results of 19 antihypertensive treatment trials spanning some 20 years of research showed that treatment had significant benefits for pressure-related complications of hypertension but generally did not prevent coronary artery disease morbidity or mortality. As possible reasons for this relative failure were explored, new emphasis was placed on the role of the sympathetic nervous system in the vascular complications of hypertension. Most risk factors for coronary artery disease strongly involve the sympathetic nervous system, which may be the final common pathway for their adverse effects. The antihypertensive drugs used in most of the large clinical trials were associated with enhanced sympathetic activity. Moreover, excessive sodium depletion caused by large doses of diuretics and dietary low-sodium intake may have contributed to the treatment's ineffectiveness in preventing primary coronary disease. The implications of the research for antihypertensive treatment are discussed, with an emphasis on the physiologically appropriate role of clonidine therapy.
Rosenman
R H
RH
Department of Cardiovascular Research, Health Sciences Program, SRI International, Menlo Park, California 94025.
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000209:etiology; D015337:Multicenter Studies as Topic; D012307:Risk Factors; D013564:Sympathetic Nervous System / Q000502:physiology*
D000959:Antihypertensive Agents