Current antihypertensive treatment: can we do better?

Results of various randomized, controlled clinical trials have shown that antihypertensive treatment is accompanied by reductions in morbidity and mortality caused by cardiovascular, cerebrovascular, and renal disease. Treatment confers a protective benefit against stroke, coronary artery disease, and heart failure, as well as against conditions previously considered unrelated to elevated blood pressure (eg, loss of cognitive function and dementia). Overall benefits of antihypertensive treatment are probably even greater than those shown in clinical trials. More rigorous blood pressure control in high-risk and multiple-risk patients provides even greater benefits. Because epidemiologic findings indicate that elevated systolic blood pressure (SBP) may be a greater risk factor for cardiovascular disease than elevated diastolic blood pressure (DBP), more attention should be paid to the control of SBP. Pulse pressure may be a better indicator of target-organ damage than either SBP or DBP, but further evaluation of its prognostic value is required. New monotherapies that can significantly reduce blood pressure, especially SBP, and confer protection on the target organs most affected by chronic hypertension may substantially add to current treatment.