Blood pressure-lowering drugs: essential therapy for some patients with normal blood pressure.

The risk of increasing blood pressure on the incidence of cardiovascular disease starts at 115/75 mmHg and roughly doubles for every 10 years increase in age, 20 mmHg increase in systolic blood pressure, 10 mmHg increase in diastolic blood pressure, or in the presence of comorbidities, such as diabetes or any evidence of cardiovascular disease. To lower blood pressure in patients with normal blood pressure and diabetes, or heart failure, or with any evidence of atherosclerotic disease in the coronary, cerebral and peripheral territories, reduces the incidence of major cardiovascular events by 18 to 42%. The diagnosis of hypertension in patients with these conditions is therefore irrelevant. The drugs that have mainly been tested in such conditions are the angiotensin-converting enzyme inhibitors, but their efficacy probably derives from their blood pressure-lowering effect, instead of a primary antiatherosclerotic effect.