On the Management of 'Mild Hypertension'

Elsewhere in this issue is a provocative article entitled "The Potential Effect of Blood Pressure Reduction on Cardiovascular Disease: A Cautionary Note," in which Madhavan and Alderman use statistical methods to analyze the benefit-risk ratio of treating elevated blood pressure (BP). The increasing number of recommendations to treat mild hypertension that have followed the report of the Hypertension Detection and Follow-up Program study,1which demonstrated that the systematic lowering of diastolic BP to goal levels of 90 mm Hg or below substantially reduced cardiovascular mortality, even in those patients with mild hypertension (diastolic BPs of 90 to 104 mm Hg), has prompted Madhavan and Alderman to urge caution lest large numbers of patients be placed on treatment programs unnecessarily. Indeed, Tarazi and I2voiced a similar note of caution in an editorial. I cannot, however, agree with either the methods of analysis used by Madhavan and Alderman or