Influence of Treatment of »Mild» Hypertension on Coronary Heart Disease

High blood pressure (HBP) in the range 90-104 DBP ("mild") has been shown to carry a sizeable excess risk of coronary death, at least in countries with atherogenic diets. Effective treatment to control HBP should result in lowering CHD risk. Early trials comparing drug treatment vs placebo in such hypertensives were generally too small or too limited to demonstrate this, although overall trends favored treatment. The U.S. Hypertension Detection and Follow-up Program (HDFP), a population based trial with 10,940 patients, did demonstrate large reductions in CHD mortality and in nonfatal CHD, as measured by a variety of indices. A subsequent large trial, the Multiple Risk Factor Trial (MRFIT), found benefit in reducing CHD deaths for most hypertensives, but for the subgroup with resting ECG abnormalities, CHD deaths were greater in the Special Intervention than in the Usual Care group. The overall findings of the several studies indicate benefit of effective antihypertensive treatment in reducing CHD mortality and morbidity for most hypertensives with DBP 90-104. However, need to highlight a number of other aspects of antihypertensive treatment is indicated: use of lowest drug level possible to achieve BP normalization; need to control all major CHD risk factors in hypertensives; need to utilize nutritional means to further both these aims; need to monitor and counteract unwanted metabolic effects of antihypertensive drug therapy.