Evaluation of the treatment of hypertension

Recent reports have demonstrated the efficacy and safety of community-wide hypertension control. This new evidence, which offers great potential for improving health and life expectancy, can be viewed as the culmination of decades of research on the treatment of hypertension. Over this period, as a number of approaches to treatment have become available, their evaluation has been conducted with increasing rigor and, especially recently, with progressively broader community applicability. This historical development illustrates the impact that long-term trials can have. Looking ahead, we ask what are the main challenges of the future in the control of hypertension? Several areas of interest are suggested: 1) To what degree can the demonstrated benefits of hypertension control be realized in different populations today? What are the obstacles to this achievement and how can they be overcome? 2) How much of the demonstrated benefit of hypertension control can be achieved by nonpharmacologic means, or by reduced pharmacologic intervention? 3) Can true primary prevention avert the development of high blood pressure itself? How does elevated blood pressure arise in relation to the normal biologic process of human development, characterized by marked "growth" of blood pressure during childhood and adolescence? The extent to which these questions might be approached through long-term trials is discussed.