Does the evidence from clinical trials justify the treatment of hypertension?
Hypertension is the most common reason for physician office visits. An estimated 43 to 50 million people in the United States have elevated blood pressure (BP). The prevalence of hypertension varies from a small percentage among individuals in their teens and 20s to more than 70% of the elderly (those > 75 years of age). The US Public Health Services (USPHS) has set a goal of having 50% of individuals with hypertension "under control"--that is, reducing their BP to < 140 mm Hg systolic and < 90 mm Hg diastolic--by the year 2000. Current information suggests that we will fall far short of reaching that goal. In the early 1990s, such levels had been achieved by only 27% of hypertensive Americans 18 to 74 years old and by only 20% of those > 75 years old. Is this a cause for concern? Is the goal defined by the USPHS justified? Should we push even harder to reach that goal, should we strive to do even better, or should we be satisfied? Since we are now in the era of evidence-based medicine, the only way to answer these questions is to review what we have learned from the many large, prospective, well-controlled, long-term clinical trials that have addressed these questions over the past 3 decades.
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Department of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents