Hypertension Detection and Follow-up

Mild Hypertension: The Question of Treatment

“…This judgment does not overlook the difficult questions that remain in completely answered (31,63,78,83). Under the auspices of the WHO and other organizations, discussions in the recent past have emphasized the world-wide concern with hypertension and its treatment and prevention (81,98).…”

“…This possibility has led to attribution, by some commentators, of the reduced mortality associated with Stepped Care to general medical care and, by implica tion, only partially to antihypertensive therapy, if at all (1,3,17,23,28,31,44,45,50,51,56,57,73,75). Several points can be offered with respect to this suggested interpretation.…”

Mild Hypertension: The Question of Treatment

“…The most frequently recurring issue concerning interpretation of the results of the HDFP has been the nature of Stepped Care management, which entailed frequent medical contacts with possible effects beyond those of antihypertensive therapy alone. This possibility has led to attribution, by some commentators, of the reduced mortality associated with Stepped Care to general medical care and, by implica tion, only partially to antihypertensive therapy, if at all (1,3,17,23,28,31,44,45,50,51,56,57,73,75). Several points can be offered with respect to this suggested interpretation.…”

“…A further question about the benefit of treatment in demographic subgroups (those defined by sex, race, or age, singly or in combination) arises from the general lack of statistically significant differences in such subgroup analyses (2,3,11,28,31,44,51,63). This issue arises, despite the obvious limitation of statistical power for subgroup analysis, because some commentators express reluctance to recommend treatment on the basis of available evidence without demonstration of statistically significant effects in any given specific subgroup.…”

“…Another issue is, at what levels of blood pressure, in relation to those in the general population, were benefits of treatment observed in these trials (31,53,63)? This question concerns the possible differences in participant selection, with respect to initial blood pressure levels, among the several major treatment trials: To whom do the respective results apply?…”