Effects of various drug regimens

Before the introduction of effective hypotensive drugs in the early 1950s, survival from untreated hypertension was closely related to blood pressure level. Cardiac failure, stroke, and uremia were the commonest causes of death. Reduction of blood pressure by antihypertensive drugs in malignant hypertension quickly showed that life could be prolonged and vascular damage arrested. The efficacy of antihypertensive drugs in nonmalignant hypertension has been demonstrated in several randomized controlled trials, but the benefit seems to decline the lower the initial blood pressure. Antihypertensive drug treatment has reduced the incidence of cardiac failure, stroke, and uremia, but it has not clearly been shown to reduce the frequency of myocardial infarctions. At present, the choice of an antihypertensive agent is based on its ability to lower pressure in relation to the possible adverse side effects that it produces. The reduction of blood pressure seems to be the basis for the therapeutic effect, rather than any other special property of the drug.