Treatment of mild hypertension

The mortality of males and females increases two-fold with increasing diastolic blood pressure (DBP) from 83 to 102 mm Hg. There is a corresponding significant increase in cardiovascular morbidity. While there is a general consensus about the need for drug treatment for those patients with DBP of 100 mm Hg or more, there is a controversy as to the justification of pharmacotherapy in the DBP range of 90-100 mm Hg. The arguments against drug treatment of patients with sustained mild hypertension with DBP less than 100 mm Hg rest on results of the large scale clinical trials, which have shown only modest benefit, not commensurate with the risks and inconveniences of pharmacotherapy. Critical appraisal of trials conducted in the past decade suggest a good efficacy of treatment of mild hypertension. Furthermore, recent studies indicate that hypertension is not a symptomless well-being. The inconveniences and side effects of treatment could be greatly reduced with lower doses and selective application of the most appropriate drugs. In a randomized, double-blind, parallel-group study of 80 patients with mild hypertension, 10-20 mg of nitrendipine once a day was an efficacious blood pressure lowering treatment with no significant difference in the incidence of side effects compared to a placebo-treated control group.