Is hypertension treated adequately?

In hypertensive patients, morbidity and mortality from the malignant phase, stroke, left ventricular failure, coronary disease and progressive renal failure are closely linked to the level of blood pressure. This relationship between blood pressure and risk can be demonstrated also when blood pressure is lowered with antihypertensive agents. Thus, it appears that the treated blood pressure level is a much stronger indicator of prognosis than is the initial untreated value. However, in the last 2 years, 3 large scale studies have shown that morbidity and mortality in treated hypertensive patients are still considerably higher than expected and significantly greater than in comparable normotensive subjects or control populations. There could be several explanations for these disturbing findings. One is that long-standing hypertension may cause irreversible cardiovascular changes that continue to put such individuals at risk, even after their blood pressure has been brought under control. Another possibility is that the pharmacological agents used in the treatment of hypertension may have some partially adverse effects in addition to their beneficial action on blood pressure. For example, drug-induced changes in serum lipids or of serum electrolytes could somewhat offset the advantages from blood pressure reduction. Furthermore, less than optimal control of elevated blood pressure could be a factor. It is worth noting that consistent arterial pressure reduction has been achieved in only a fraction of treated patients in the large scale intervention trials.(ABSTRACT TRUNCATED AT 250 WORDS)