Establishing the effect of antihypertensive treatment on coronary morbidity and mortality.

The results of the major antihypertensive trials are reviewed. Most of them were too small to detect significant differences on coronary heart disease (CHD) incidence. The pooled result was not significant for the effect on CHD; for stroke it was significant in some of the individual trials and significant when the data were pooled. The results of treatment in a general population sample and the 'J'-shaped curve relation between achieved blood pressure and CHD incidence are discussed. Reasons for the stronger effect on stroke compared with CHD, may be: A longer treatment period needed to affect CHD. --Effects on other risk factors such as lipid levels and smoking are needed to influence CHD incidence. Negative metabolic effects from treatment may be counteractive. More basic mechanisms in the process leading to hypertension and CHD may have to be affected.