[Hypertension and cardiovascular damage].

All major randomized trials of antihypertensive therapy have used cardiovascular events as endpoints. This approach has provided important information, but has also led to a few inappropriate conclusions. In particular, no sound information is available on the ability of antihypertensive therapy to prevent the cardiovascular lesions upon which events are superimposed. However, particularly in mild to moderate hypertensives, the primary goal of therapy is prevention of cardiovascular lesions rather than prevention of premature death. Sensitive and quantitatively reliable methods for evaluation of organ damage in hypertension are now available. For instance, the quantitative evaluation of coronary plaques has recently been employed in therapeutic trials of coronary artery disease; non-invasive methods (such as quantitative ultrasonography of carotid artery walls) can be employed in large trials of antihypertensive therapy to answer the question whether some class of antihypertensive drugs, such as calcium-antagonists) may be more effective in prevention and/or regression of atherosclerotic plaques than traditional antihypertensive agents.