Treating mild hypertension--an unnecessary luxury.

Clinical practice should be based on the results of good clinical trials, not on the opinion of individual doctors. This is particularly true of high blood pressure, for there is no disease of "hypertension," and only through clinical trials has the acceptable upper limit of blood pressure been identified. The large trials that have been performed, and in particular the MRC trial of bendrofluazide and propranolol, enable the benefits of treatment to be assessed and related to the incidence of unwanted effects of treatment. Many new drugs, which are usually very expensive, have not been subjected to large clinical trials and a "balance sheet" of their benefit and adverse effects cannot be drawn up. Drugs that have not been assessed in large trials must be regarded both as an unnecessary and an undesirable luxury.