Comparison of high-risk and mass strategies for the prevention of high blood pressure

A mass strategy for the prevention of high blood pressure and its complications is likely to be more effective than high-risk strategies for several reasons: there is no practicable way of identifying in advance a large proportion of future hypertensives; a minority of hypertensive complications occur in individuals with pressures high enough to warrant treatment; and treatment has little or no effect on the incidence of the major hypertensive complication, coronary heart attacks. The effect of a broad-based dietary prevention programme is not proven, but such a strategy offers a reasonable prospect of a broad range of benefits, and is likely to prove acceptable to the general public. A family-based approach may contribute to aetiological research, and make pragmatic sense in clinical practice, but does not provide a scientific basis for a high-risk strategy of prevention.