Essential hypertension--therapeutic implications of epidemiological risk estimation.
Epidemiological studies have repeatedly shown a relationship between blood pressure and the risk of disease and death. With rare exceptions, such studies have demonstrated a steadily increasing level of risk throughout the entire range of systolic and diastolic blood pressure with no evidence of a threshold for blood pressure-related changes in morbidity and mortality. Estimates based on community prevalence and attributable risk indicate that the majority of blood pressure-related cardiovascular complications can be attributed to the effects of only slight increases in blood pressure. Any attempt to substantially reduced blood pressure-related morbidity and mortality in the community mandates treatment of a large number of asymptomatic subjects who, on average, have only a slight increase in absolute risk. The most appealing public health approach to the epidemic of blood pressure-related complications in Western countries is the combined use of mass and high risk treatment strategies. Mass strategies could include a number of non-pharmacological interventions which aim to slightly shift the entire distribution of blood pressure, whereas high risk strategies are based on the more traditional combined drug and non-drug approach to antihypertensive therapy of subjects in the upper end of the blood pressure distribution. At present the efficacy and practicality of community-based non-pharmacological interventions remains unproven. In addition, several important questions related to antihypertensive drug administration require clarification.
D000206:Actuarial Analysis; D000368:Aged; D001315:Australia; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D004739:England; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality* / Q000628:therapy; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012306:Risk; D014481:United States