Implications for research and policy in the treatment of hypertension. Medical considerations.

Hypertension, or high blood pressure, is a disease and a risk factor. Cardiovascular risk is directly proportional to the level of blood pressure. Current therapeutic approaches include the classical medical model of detection, evaluation, and drug treatment of high-risk patients who have elevated blood pressure and also a less-well-studied population approach that seeks to manipulate environmental variables in large groups of subjects to reduce blood pressure and subsequent cardiovascular risk. Future research should center on more precise delineation of cardiovascular risk, evaluation of alternative environmental manipulations to reduce blood pressure, enhanced understanding of the pathophysiological mechanisms of hypertension, better matching of antihypertensive drug therapy to pathophysiology, development of new drugs that not only lower blood pressure but also provide additional benefits with minimal side effects, and finally, investigations to further our understanding of the behavioral aspects of the physician-patient encounter, as well as studies on compliance and other issues that influence therapeutic outcome.