Drug therapy in hypertension: risks and benefits

Controlled clinical trials have confirmed the benefit of antihypertensive therapy with drugs in moderate and severe hypertension. There is little doubt that the benefits in reduction of stroke and heart and kidney failure in these patients greatly exceed any risks of long-term drugs. In mild hypertension, benefit for the individual may be less easy to identify. Long-term drug therapy in mild hypertension may interfere with the quality of life through symptom side effects or even increase overall cardiovascular morbidity by adversely affecting other risk factors, such as lipids or serum potassium. Although the majority of patients will require drug therapy, nonpharmacological approaches are preferable if they can be used, as long as they themselves do not introduce any new hazards. It remains to be seen whether different drug regimens are associated with differences in long-term outcome.