Cardiovascular consequences of hypertension: therapeutic effects on organ damage and on cardiovascular events.

All major randomized trials that have tested the effectiveness of antihypertensive therapy have exclusively or almost exclusively been based on mortality and morbidity data (fatal and non-fatal strokes, fatal and non-fatal myocardial infarctions, sudden cardiac deaths, cardiovascular mortality, mortality by any cause). Thus, trials based on the monitoring of events have succeeded in ascertaining the achievement of the most important goals of treatment of any morbid condition--the prolongation of life and prevention of incapacitating morbid events. However, a clear distinction has to be made between cardiovascular events, as measured in any randomized trial of antihypertensive therapy, and the underlying vascular lesions, which have never been measured in large randomized therapeutic trials. Therefore, the results of therapeutic trials based on events cannot be applied towards the conclusion that antihypertensive therapy has similar effects on the underlying disease. Indeed, the mechanisms responsible for the precipitation of events are often different from the mechanisms leading to disease. Both the prevention of cardiovascular events and prevention of organ damage or disease are essential goals of antihypertensive therapy. As the mechanisms leading to vascular injury and to events are, to a significant extent, different, the achievement of the two goals has to be evaluated through trials that use, separately or conjointly, different criteria--either cardiovascular events, or one or more measures of cardiovascular injury. Trials based on cardiovascular injury are now possible due to the relatively large number of quantitatively precise and reproducible techniques for evaluating organ damage accompanying hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)