The Role of Blood-Pressure Control in Preventing Complications of Hypertension

The modern treatment of hypertension

“…Such studies have been conducted with remarkably varying competence from the time of the pioneering work of Hamilton and his colleagues in England in 1964. 7 Because the evolution of increasingly more effective and acceptable antihypertensive agents has paralleled developing expertise in clinical trial methodology, it is perhaps inevitable that the frailties of some initial essays in this field have been exposed. 6 Even so, it is disturbing to find several commentators overlooking often major defects of certain trials, and, consequently, presenting over-optimistic interpretations of the benefits of therapy.…”

“…7, 9, 10, 11. Hamilton et al, 7 MRC Working Party, 9 and Veterans Admin Coop Study Group. 10,11 effect with presenting diastolic pressures as low as 90 mm Hg and upwards.…”

“…In that of Hamilton et al, 7 for example, while it was the first controlled trial to evince benefit, patients were allocated to therapy alternately as they presented at the clinic, rather than at random, and for that reason Hamilton's study has often been excluded from meta-analyses.…”

The 1964 trial of antihypertensive treatment

“…1,2 I was very pleased that you also referred to the paper by Leishman of 1961. 3 Despite its obvious defects, this was the first paper convincingly to demonstrate the eronmous benefits of antihypertensive therapy, particularly in respect of stroke, heart failure and renal failure in patients with nonmalignant hypertension.…”

The 40th anniversary of the publication in 1964 of the first trial of the treatment of uncomplicated, severe hypertension by Hamilton, Thompson and Wisniewski

“…1 Previous open studies had been confined to patients with very severe or malignant phase hypertension. 2,3 They were mainly based on historical or retrospective controls and therefore could not be regarded as true clinical trials.…”