Hypertension 1973: Treatment—Why and How

Controversy on the merits of long-term antihypertensive therapy no longer exists. Recent studies have dramatically shown that arterial pressure should be reduced in all patients whose diastolic pressure exceeds 105 mm Hg. Persistent control of pressure will significantly reduce cardiovascular morbidity and mortality resulting from the hypertensive diseases. The value of pressure reduction in individuals having diastolic pressures between 90 and 105 mm Hg, or systolic hypertension, and the effect of early treatment of hypertension in retarding development of atherosclerosis remain to be shown. Still subject to clinical judgment are more sophisticated questions about the extent of clinical diagnostic evaluation and the proper course of therapy: should a standard therapeutic regimen or specific individualized therapy tailored to the clinically identified pressor mechanisms be pursued? Hypertension, afflicting over 20 million American adults, is a major public health problem that demands innovative measures and the establishment of effective medical and social programs of preventive cardiology.