The role of medicine in the decline of hypertension-related mortality.

Mortality trends are often cited to justify public health priorities and to legitimate professional activities. For example, the decline of cardiovascular disease mortality in recent decades has been cited frequently as affirmation of the proper conduct and direction of medical and public health research. In this paper, the hypothesis that medical intervention is the major cause of hypertension-related mortality declines is reviewed. Evidence relevant to the "medical hypothesis," including mortality data and patterns of antihypertensive drug development and treatment, is presented. While it is clear that factors other than medical intervention must have played the major role in hypertension-related mortality trends for most of the period of the decline, much scientific literature increasingly promotes the view that medical intervention is the crucial factor in mortality trends. The role of the medical hypothesis in supporting status quo political and economic interests is discussed, and alternative explanations for mortality trends are considered.