Problems in the treatment of hypertension

The major problems discussed and the responses are: (1) Is blood pressure measurement by ordinary sphygmomanometer still valid as a guide to decisions? Yes. (2) Is translation of population into individual risk based on blood pressure alone appropriate as the sole criterion for treatment? No. All risk factors and observation time are important. (3) Does a good response to medical treatment preclude full investigation? No. Knowledge is better than ignorance. (4) Are trial results useful clinically? Yes, if selection of subjects, major risk factors, and relative benefits of treatment are clearly presented. (5) Do some drugs have beneficial effects on stroke and myocardial infarct other than purely those due to lowering of pressure? Yes: bendrofluazide and stroke. (6) Can smoking interfere with beneficial effects? Yes: propranolol and stroke. (7) Have some drugs serious adverse effects? Possibly thiazide in myocardial ischaemia. (8) Is it dangerous to lower the diastolic pressure below 90 mmHg? Possibly. (9) Is there a hypertension treatment paradox in stroke and myocardial infarct? Yes.