Hypertension and heart disease. The need for clear thinking

Hypertension is a major risk factor for vascular disease-cerebral, cardiac and peripheral. The systolic blood pressure is the most important prognostic factor. An extensive work-up searching for a cause is not indicated. Controlling hypertension has been shown to decrease incidence of stroke, heart failure, myocardial infarction and sudden death. Thiazide and beta-blockers have stood the test of time and have the best track record in preventing complications of hypertension. Surrogate endpoints of therapy, such as effect on insulin resistance, are interesting from an academic point of view. But they are no substitute for randomised clinical trials and the real endpoints of stroke, myocardial infarction and sudden death.