Fluctuation

D ow nloaded from DOI: 10.1161/CIRCULATIONAHA.112.124750 2 Effective drug treatment of hypertension for prevention of fatal and non-fatal cardiovascular disease passed its 50th anniversary two years ago 1. Until recently, the most consistent observation among trials had been that stroke risk was directly related to the fall in blood pressure on treatment 2. Older trials established the value of anti-hypertensive drug treatment (AHT) and generally recruited disease free participants at their outset. Recent trials have focused on less healthy participants. Recruitment has been extended to those with a prior stroke, recent myocardial infarction, coronary artery disease, chronic renal disease (with or without diabetes), heart failure, combined high-risk states and the elderly (old-old). The benefit of AHT is still related to the reduction in blood pressure 3. Differences between drug classes for have been found in some, but not all trials; the differences are generally small, even if statisticall