Lessons from hypertension trials.

Hypertension is a well-established risk factor for stroke, myocardial infarction (MI), and premature cardiovascular death. Even mild elevations of blood pressure (i.e., diastolic blood pressure >90 and <110 mm Hg) yield increased risk. In fact, mild-to-moderate hypertension is more common than severe hypertension and accounts for a greater proportion of the deaths and serious nonfatal vascular events. The treatment goal is to make optimal use of antihypertensive drug therapy while encouraging patients to implement lifestyle changes such as weight loss, sodium restriction, decreased alcohol intake, and increased exercise. Pharmacologic therapy of mild-to-moderate hypertension can significantly reduce the incidence of stroke, MI, coronary artery disease, vascular mortality, and total mortality. Beta blockers and diuretics should continue to be used as first-line therapy until there is direct and reliable evidence from large-scale randomized trials with clinical endpoints for newer agents such as calcium antagonists and angiotensin-converting enzyme inhibitors.