Appraisal of Antihypertensive Drug Therapy

Four completed prospective studies of drug-treated and control hypertensives utilizing double blind randomized protocols are reviewed for the purpose of evaluating the evidence on which the present therapeutic crusade is based. Patients studied were predominantly male, observed for short period, had complications or died at young age, had high incidence of previous target organ vascular disease, and did not include those whose blood pressure fell to normal with hospitalization alone. Incidence of complications associated with coronary artery disease was the same in control and treated patients. The rapidly progressive disease observed in these patients differs from that described in other natural history studies. Population screening for hypertension for the purpose of instituting drug therapy is premature because the value of antihypertensive drug treatment for the general hypertensive population has not been established.