Issues in the treatment of hypertension: current and future perspectives

The benefits of lowering elevated arterial blood pressure have been documented in many intervention trials. Initially, such studies included only patients with malignant hypertension, and very convincing improvements in the 5-year survival rate were demonstrated in several reports. Subsequent large-scale intervention studies included patients with non-malignant forms of hypertension. Again, significant improvements in cardiovascular morbidity and/or mortality were shown. Recent epidemiological data from the USA and Sweden suggest that the pattern of hypertension and its associated morbidity is changing, probably due to earlier diagnosis and treatment. The aims of this review are to describe some of the important steps that have been taken in the area of hypertension over the last few decades and to try to evaluate the status of current antihypertensive therapies. Particular emphasis will be given to discussing some of the issues and questions that are currently under investigation, for example the status of novel therapies, such as calcium channel blockers and angiotensin-converting enzyme inhibitors, and the issue of the level to which blood pressure should be lowered in order to extract the maximum benefit from antihypertensive treatment. Some of the ongoing large-scale intervention trials in hypertension will also be reviewed.