The evolution of antihypertensive therapy.

The goal of antihypertensive therapy has changed dramatically over the past 40 years. What was once a treatment for a life-threatening disease has gradually evolved to become just one of the many ways of modifying a symptomless risk factor. The development of safer drugs throughout the 1970s resulted in treatment being offered at successively lower levels of blood pressure elevation, and consequently to an ever increasing proportion of the population. Based on new evidence from clinical trials, however, recent policy guidelines for the treatment of hypertension--especially mild hypertension--have become more conservative. Yet, there are a number of reasons for doubting that this policy reversal will be transmitted into actual clinical practice, unless major changes are made to the arrangement of structural interests--professional, industrial and third-party funders--which currently support and maintain antihypertensive therapy on a mass scale. Meanwhile, 'control' of blood pressure, 'quality of life', and 'compliance' with therapy have become ends in themselves, often to the exclusion of much-needed discussion on the real therapeutic goal of antihypertensive medication, i.e., the prevention of cardiovascular and cerebrovascular morbidity and mortality and the question of whether drugs are always the best way to achieve this.