Recent advances in the management of hypertension

Advances during the past 4 decades in the management of hypertension include the following: a clearer understanding of the precursors of essential hypertension; encouraging attempts at primary prevention in high-risk individuals and in entire populations; establishment by observational studies and clinical trials of the causative relationship between hypertension and cardiovascular diseases (CVD) and of the ability to prevent these complications by reduction of elevated blood pressure levels; the success of public and professional education in improving detection and management of hypertension and, thereby, reducing CVD mortality rates; the demonstration during clinical trials of possible adverse effects of antihypertensive therapy, which reduce the effect of blood pressure reduction efforts to prevent coronary heart disease (CHD); growing appreciation of the value of nonpharmacologic approaches for lowering blood pressure levels on primary prevention of hypertension, management of hypertension, and for reducing dosage or allowing withdrawal of antihypertensive drugs in patients under good blood pressure control; awareness of the need for simultaneous management of other risk factors for CHD in patients with hypertension; a growing armamentarium of drugs to help control elevated blood pressure by different mechanisms with fewer adverse reactions than earlier drugs; and the evolution of a more flexible, individualized approach to the drug treatment of hypertension that takes into consideration patient characteristics, co- existing medical conditions, and factors affecting quality of life.