[Therapy of arterial hypertension: benefits, costs, challenges].

For more than 30 years the benefits of antihypertensive therapy have been assessed by randomized trials measuring cardiovascular events. Even greater benefits are found if prevention of congestive heart failure, left ventricular hypertrophy, and progression to more severe hypertension are considered. Quantifying the benefits in order to calculate cost-effectiveness of treatment is not easy, however. Taking absolute risk and absolute benefit as a guide to treatment decision, though an important approach, may result in limiting therapy to elderly and complicated hypertensives only. Furthermore randomized trials, whose duration is necessarily short, are likely to underestimate treatment benefits. An alternative is the actuarial approach, by which treatment benefits are calculated from the actuarial data showing the reduction in life expectancy associated with any given blood pressure increase. The cost of antihypertensive therapy per year of life gained, as calculated by the actuarial approach, is much lower than the cost calculated on the basis of the outcomes of randomized trials. In an uncertain area such as that of cost-effectiveness evaluation, it is important that both approaches be brought to the consideration of physicians, patients, politicians, and officers of national health systems.