Aims of treatment of hypertension.

The major aim of treatment of arterial hypertension is to reduce the increased risks of cardio-cerebrovascular morbidity and mortality that are associated with elevated blood pressure (BP). A direct relationship can be found between the level of BP and risk, even down to what is normally considered to be the "normotensive range", i.e., diastolic BPs of 80 mm Hg. Moreover, when considering that the risk in treated hypertensive patients is more closely linked to the BP level achieved during treatment than to the initial untreated level, it becomes obvious that the aim should be to lower elevated arterial pressure to strictly "normotensive" levels. Recently, the results of several large-scale trials have shown that treated hypertensive patients still have an increased risk for morbidity and mortality, compared with normotensive subjects recruited from the same population and of the same sex and age. The main reason for this appears to be inadequate control of BP. Since mortality and morbidity from coronary heart disease (CHD) still constitute the major risk in hypertension, special efforts should be directed towards this problem. In addition to the obvious need for better control of BP, there appears to be a need also for direct measures against CHD. The beta-blockers are therefore of particular interest. Despite the fact that the large-scale Medical Research Council (MRC) and the International Prospective Primary Prevention Study in Hypertension (IPPPSH) studies only indicated that beta-blockers could have a primary preventive effect against CHD in nonsmoking male patients, the possibility that beta-blockers may in fact have a primary preventive effect against CHD in hypertension is still logical.