Has Antihypertensive Treatment Prevented Vascular Disease or Vascular Events?

Our current knowledge of the effects of antihypertensive therapy is based on a large number of therapeutic trials based on mortal and morbid cardiovascular events. Although these events are indeed "hard" data, extrapolations from the results of trials based on events cannot be applied to possible effects on the underlying cardiovascular disease, particularly coronary artery disease, as the mechanisms responsible for the precipitation of events are often different from the mechanisms leading to disease. Once a distinction between prevention of disease and prevention of events is made, then both must be considered to be different, but essential, goals of antihypertensive therapy. The prevention of events is a short-term goal for patients who already have disease, and can be easily appreciated by traditional event-based trials; the prevention of disease, however, is a long-term goal that can be appreciated clinically only after years of treatment, but can be assessed within a shorter time frame by measuring plaque development, as in new types of randomized trials. Studies of the potential actions of antihypertensive drugs on the mechanisms precipitating events, particularly thrombotic factors, may further supplement our current knowledge in our search for the most appropriate treatment of the hypertensive patient.