The Art of Prediction and Prevention

The prognostic medical importance of detecting and treating hypertension has been repeatedly demonstrated by carefully planned and conducted clinical trials. Predicting responses and prognosis after therapeutic interventions has been a major issue in hypertension research during the last three decades [l]. Several of the contributions in this issue of BLOOD PRESSURE relate to the important issue of prediction, in particular prediction of therapeutic response and preventive efforts in the hypertensive population. In the Guest Editorial [2] Chalmers points out some of the most important and challenging research areas defined by WHO-ISH [3] within the hypertension field. Among those that rank highest are the issues relating to firm evidence of perceived benefit of the “newer” antihypertensive agents, as well as the potential prognostic impact of treating associated risk factors such as left ventricular hypertrophy and proteinuria in the hypertensive population. These as well as other challenges in hypertension research need investments in terms of funding, time and brainpower. However, performing these trials will of course not provide us with the ultimate answers. Novel genetic markers, such as ACE (D/I) polymorphism [4] call for adequately designed prospective clinical studies in order to evaluate whether they may represent putative risk markers in the hypertensive population. Needless to say, the questions will be many and answers hard to come by. In order to obtain the desired premium of asking the right questions and spending our limited research resources, this new scene calls for novel designs of future trials and major joint efforts within the hypertension research community in conducting such trials. In full agreement with Chalmers we firmly believe that such investments will be worthwhile.