The necessity for recognition and treatment of patients with "mild" hypertension

A dramatic evolution has occurred in the past four decades in our underlying knowledge of pathophysiology of the hypertensive diseases and in the availability of myriad pharmacologic agents for control of hypertension. This report provides a current review of antihypertensive treatment interspersed with personal opinions supported by appropriate references. It focuses on the recent national recommendations dealing with the prevention, detection, evaluation and treatment of the disease (JNC-6). Whereas I believe that the height of arterial pressure is of primary importance, it is not the sine qua non explaining all target organ involvement or complications of hypertensive disease. Consequently, all that is classified today as Stages 1 and 2 hypertension (old terminology: "mild" and "moderate") in terms of blood pressure elevation does not explain all outcomes of disease. Indeed, JNC-6 introduced the new concept of risk stratification for therapy based not only on the height of systolic and diastolic pressure but also on the presence of target organ involvement, comorbidity and other risk factors. However, after considerable advances since the inception of the National High Blood Pressure Education Program (NHBPEP) in 1972, it appears that we are avoiding our responsibilities and reversing our gains. It is of vital importance that we renew our efforts to identify, evaluate and treat all patients with hypertension; this is especially so for the vast numbers of patients with Stages 1 and 2 hypertension.