Do No Harm

Despite tremendous advances in our knowledge of the factors responsible for cardiovascular disease, massive detection and public and professional education programs, and the introduction of effective new agents for the treatment of these risk factors, cardiovascular disease remains the number 1 cause of death in America and most of the industrialized world. Hypertension remains a major risk factor for these disorders despite marked improvement in the identification of those with elevated blood pressure and its treatment. The introduction of antihypertensive drugs more than 30 years ago was met with lukewarm utilization until the publication of the dramatic results of the Veterans Administration Cooperative Study in patients with severe hypertension (diastolic pressure >114 mm Hg).¹This study reported a marked decrease in mortality with antihypertensive therapy in comparison with a group receiving placebo only. Subsequent reports by the same investigative group in those with mild to moderate hypertension, although not