[Current topics on the detection, evaluation and treatment of hypertension]

Since hypertension is one of the major important risk factors for coronary heart disease and the most important risk factor for cerebrovascular diseases, recent progress in the detection and management of hypertension has contributed to the morbidity and mortality declines. However, some problems of how to detect, evaluate and treat hypertension in clinical practice have remained to be solved. First, classifications of blood pressure monitoring at home and/or work and 24-hour ambulatory blood pressure monitoring based on impact on risk of cardiovascular diseases are not available, whereas there is increasing evidence that out-of-office measurements of blood pressure are more helpful in detecting hypertension, evaluating severity of hypertension and judging the effectiveness of treatment, than in-office measurements. Secondly, nonpharmacological treatment of hypertension which include weight reduction, increased physical activity, and moderation of dietary sodium and alcohol intake offer multiple benefits at little cost and with minimal risk. However, the role of nonpharmacological treatment to reduce morbidity and mortality of cardiovascular diseases has not been clearly established. In addition the evidence from randomized trials, directly comparing drug therapy and nondrug therapy of mild hypertension is not in favor of the cost-effectiveness nor even of the medical effectiveness of the nonpharmacological treatment of mild hypertension. Finally, the benefits of therapeutic strategies for treating patients with mild hypertension, elderly patients with isolated systolic hypertension and patients with cardiovascular disease complication have not been evaluated in long-term intervention trials especially in Japan.