The four seasons of anti-hypertensive therapy

The development of anti-hypertensive therapy and its achievements over the last 40 years are reviewed. The following are identified as the still unanswered questions: the pharmacological treatment of mild hypertension; the limited efficacy of anti-hypertensive therapy in the reduction of the number of myocardial infarctions; the negative effect of some types of antihypertensive treatment on plasma lipids; the lack of efficacy of some drugs in reducing left ventricular hypertrophy; the difficulty in establishing the optimal levels of blood pressure and often the difficulty in achieving those levels.