Should We Treat `Mild' Hypertension?

MILD, essential hypertension has been defined as the "gray zone" between normal BP and essential hypertension that clearly warrants treatment.¹While many agree that in adults diastolic BP (DBP) below 90 mm Hg is "normal," this upper limit is artificial. The Framingham study has been interpreted as showing a linear relationship between the subsequent development of cardiovascular disease and baseline DBP over 60 mm Hg²(although this interpretation has been disputed).³Normal DBP depends on age, sex, and race; but the use of 90 mm Hg as the universal upper limit of normotension seems safe and utilitarian. Defining the lower limit of DBP that clearly demands treatment is even more difficult. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure recommends that all patients with a DBP of 105 mm Hg or greater be treated.⁴The clinical effectiveness of treating such patients was shown