Effects of antihypertensive treatment on prognosis

Knowledge of the benefit of antihypertensive treatment relies on several large-scale trials, such as the Veterans Administration (VA) Studies, the Hypertension Detection and Follow-up Program (HDFP), the Australian National Blood Pressure Study (ANBP Study), and the Gothenburg Primary Preventive (GPP) study. These studies have shown that antihypertensive drugs decrease the incidence of directly hypertension-related complications like stroke, cardiac decompensation, and accelerating hypertension. It is less clear whether they influence the incidence of coronary events. In the HDFP, the ANBP Study, and the GPP study, the participants were recruited by screening large proportions of the total population. The proportion of the total screened population who met the inclusion criteria and hence were included was 3.3% in the ANBP, 6.9% in the HDFP, and 13.6% in the GPP trial. In most Western countries a substantially larger proportion of the total population is already being treated for hypertension. It is therefore not possible to use the results of these studies to justify treatment of larger segments of the population than we treat today. This is especially important because the milder the hypertension, the less effective the treatment is; hence, more patients will be given treatment without deriving benefit from it.