title: Management of hypertension: risk-benefit ratio.
abstract: The justification for drug treatment of mild hypertension rests upon epidemiological data demonstrating an increased risk of heart attack and stroke and a very small number of controlled clinical trials. These data provide a slender basis for mass treatment and leave many vital questions unanswered. The incidence of stroke (and heart attack in some countries) appears to be falling irrespective of antihypertensive therapy. Are historic epidemiological findings still relevant? The level of diastolic blood pressure where risk begins to increase appears to be about 95 mmHg. Ought this also to be the target value for blood pressure reduction? Do thiazide diuretics have added risks and beta-adrenergic blocking drugs added benefits over and above their effect upon blood pressure? If the MRC Hypertension trial turns out to be the last of the big placebo controlled trials in hypertension how shall we assess the effects of new types of drugs upon outcome?
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D001581:Benzothiadiazines; D001794:Blood Pressure / Q000187:drug effects; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D002986:Clinical Trials as Topic; D004232:Diuretics; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control; D012306:Risk; D012737:Sex Factors; D012907:Smoking; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors