[Treatment for prevention of complications. The case of hypertension]

Nowadays treatment of risk factors seem to be most successful than treating illness itself or its complications. The importance of prospective international surveys in reducing complications has been underlined. From an epidemiological point of view, therapeutic strategies have proved to be more eficacious when applied to the whole hypertensive population than to selective high risk groups. Historically, tendency was aimed to lower diastolic blood pressure, classically a marker of essential hypertension. At present, trends seem to indicate that prognosis is more influenced by systolic hypertension, mainly in the aged. As aging progresses, diastolic pressure tends to decrease, arteries become rigid, cardiac output diminished and pulse wave velocity increases enhancing quick blood return to the heart at the end of systole. All these changes heighten blood pressure, overload the heart and diminish coronary flow. It has been recently reported that lowering diastolic blood pressure under 85-80 mmHg leads to coronary insufficiency or death. HOT study is under way in order to achieve the right criteria on this point. In our view, a key figure is not going to be the answer for everyone.