Mild Hypertension: The Question of Treatment

"Mild" hypertension is a major public health problem, not only in the US , but in many other areas of the world. It is a predictor and an important causal factor for a large proportion of premature mortality and morbidity as well, due principally to cardiovascular complications. Its prevalence is such that millions of adults, in the US alone, are currently or potentially affected by policies and practices concerning its treatment to prevent these complications. The feasibility of reducing the risks of complications, as reported from controlled clinical trials, appears to be accepted generally, though not universally. Guidelines to accom­ plish this on a national and even international scale have been published, and they have been adopted widely in some countries. Thus, in the US for example, the proportion of persons detected and classified as hypertensive who are under treatment with effective blood pressure reduction has increased markedly since the early 1970s. Still, in some demographic groups with especially high prevalence, hypertension (predominantly "mild") remains largely uncontrolled (89). From the public health point of view, we are thus confronted with a problem of great importance, the availability of an effective response, and the evident need to bring further efforts to bear, if progress is to continue toward reduction of avoidable risks in the population at large. Treatment of "mild" hypertension is not a matter free of controversy, howev­ er. The recent literature reflects differences of judgment in several areas, including: (a) the true benefit of blood pressure reduction in relation to particu­ lar levels of pressure at the start of treatment; (b) the nature and extent of adverse consequences of treatment, chiefly from antihypertensive drugs; and (c) the proper role of "nonpharmacologic therapy." The importance of these