Hypertension--indications, goals and potential risks of drug therapy.

Double-blind, placebo-controlled studies show that drug treatment of hypertension does not significantly reduce morbidity and mortality at diastolic pressures less than 105 mm of mercury. Nevertheless, most physicians start drug therapy at 90 to 104 mm of mercury. Few reports have dealt with the level to which blood pressure should be reduced. Available data, including reports from two large-scale studies, suggest that excessively low diastolic pressure due to drug therapy may cause an increase in deaths from coronary heart disease. Other studies suggest that reducing diastolic pressure below 100 mm of mercury does not enhance the prevention of complications of hypertension nor the reversal of pretreatment secondary change. Therefore, it is suggested that drug treatment of hypertension should be begun only if diastolic pressure is consistently 105 mm of mercury despite hygienic measures of treatment. A goal diastolic pressure of at least 100 mm of mercury is suggested.