Review of primary prevention trials

The main threat to patients with mild to moderate hypertension is coronary heart disease (CHD), but controlled trials of antihypertensive drug therapy have given disappointing results: overall, the reduction in CHD mortality (11%) and morbidity (10%) were small and nonsignificant. Recent trials comparing a beta blocker with other antihypertensive drugs have not shown the "cardioprotection" expected from their pharmacologic actions and from their effectiveness after myocardial infarction; but two large trials have suggested some reduction in CHD among male nonsmokers. Relaxation with biofeedback possibly lowers CHD risk. Although the trials indicate that drugs generally do little to reduce CHD in hypertensive patients, control of smoking and serum cholesterol may be more effective.