Hypertension trial results: consensus and conflicts.

In severe and accelerated hypertension the benefits of treatment are clearcut. In patients < 60 years of age with mild hypertension the main benefit is reduction of stroke by about 40%. The death rate from stroke is declining in many affluent countries for reasons which can only be partly explained by mass treatment of hypertension. In the MRC trial in patients < 60 years old it took 2500 patient/years of treatment to save one stroke. If the number of strokes is declining for other reasons the number of patient/years to save one stroke may be increasing. In older patients the absolute benefit is greater because they suffer more stroke events and because treatment also reduces coronary events.