The large studies in hypertension: what have they shown?

Should the costs of development inhibit research into new antihypertensive drugs?

“…Several studies have shown that treatment does not return cardiovascular risk to that of a normal population drawn from the same catchment area [5][6][7]. In particular, antihypertensive therapy has made little or no impact on coronary artery disease and its consequences, despite the evident association between coronary disease and hypertension [1,2,9]. Moreover, the fatality rate of stroke, although lowered by treatment, remains substantially higher than in a normal population [7].…”

“…Prince of Wales Hospital, Chinese University of Hong Kong and Janssen Research Foundation, Beerse, Belgium albeit to an extent that cannot now be determined [1,2,4].…”

“…The malignant phase and hypertensive heart failure can be cured or prevented, and prophylactic antihypertensive drugs have been shown to diminish the attack l~ate of stroke and to retard the speed of progression of hypertension-related renal functional impairment [1][2][3].…”

A long‐term study on the effect of pindolol on serum lipoproteins: a preliminary report.

“…While recent large studies (see Robertson, 1987) suggest that the treatment of moderate hypertension leads to a reduction in mortality and morbidity from stroke it does not generally appear to reduce the increased incidence of myocardial infarction in hypertensive patients (Wilcox et al, 1986). One possibility which has been discussed concerning the apparent lack of effect on myocardial infarction is that therapy itself might have a negative influence on other risk factors for myocardial infarction such as serum lipids and lipoproteins (Perez-Stable & Cavalis, (1983).…”

Individualization of antihypertensive therapy.

“…1 -3 At present, the selection of a drug for an individual hypertensive patient is usually based on trends derived from large-scale randomized clinical trials, 4 on various rigid stepped-care programs recommended for current practice, 5 or on indices such as age, renin, or race, whose predictive value for the antihypertensive efficacy of a given LETTERS TO THE EDITOR drug has been suggested by statistically significant correlations valid for large groups of selected and heterogeneous patients. 6 Improvements in the evaluation of blood pressure changes used together with appropriate designs for sequential drug administration will allow for a more precise analysis of the efficacy of drugs in a given patient, thus offering a clinically based approach for optimization of individual therapy.…”