Lessons learned and future directions.

The definition of high blood pressure needs to be made more clinically relevant and predictive of future cardiovascular sequelae. Age, sex, genetic factors, diet, environment, behavior, and mental attitude can influence hemodynamics and cardiovascular outcomes. The greater the number of blood pressure determinations, the more valid the diagnosis of hypertension. Mean daily blood pressure determined by ambulatory monitoring is generally conceded to be the most significant prognosticator but is not suitable for routine use. Psychophysiologic stress testing may provide a means of estimating the mean daily blood pressure. Carbon dioxide rebreathing and other techniques being investigated may also provide useful hemodynamic measurements. Because of the adverse impacts of antihypertensive medications, nonpharmacologic approaches to treatment may be preferable where possible. Biofeedback and relaxation techniques have benefited certain persons. A comprehensive program that includes additional approaches has provided significant improvements and is briefly described. An overview of the conference presentations is also included.