This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Safar, M. E. Search for Related Content PubMed PubMed Citation Articles by Safar, M. E. Related Collections Cardiovascular Pharmacology Clinical Studies Epidemiology Other Vascular biology

(Circulation. 2001;103:1188.)
© 2001 American Heart Association, Inc.

Editorial

Epidemiological Findings Imply That Goals for Drug Treatment of Hypertension Need to Be Revised

M. E. Safar, MD

From the Department of Internal Medicine, Broussais Hospital, Paris, France.

Key Words: Editorials • epidemiology • pharmacology • hypertension • arteries • elasticity

In the early trials exploring the benefit of antihypertensive drug treatment, diastolic blood pressure (DBP) was chosen as the only criterion for patient inclusion. This choice had, by definition, influenced the baseline characteristics of the hypertensive population.¹ The subjects with both high systolic blood pressure (SBP) and low DBP and, hence, with a selectively increased pulse pressure (PP) were excluded from the trials and, therefore, not analyzed in the primary results. This bias was introduced not only in selecting the subjects at inclusion, but also at the end of follow-up. Those with an elevated SBP were considered adequately treated, although only DBP had been normalized (90 mm Hg). Perhaps for these reasons, antihypertensive drug therapy was consistently shown to prevent stroke more than it prevented ischemic heart disease.¹ Such findings suggested that more attention should be given to SBP² and PP,³ both of which are better independent predictors of cardiovascular (CV) risk than DBP alone.

In recent years, numerous therapeutic trials using SBP as the principal inclusion criterion were performed in elderly populations. Cardiac events were reduced by 24% to 27%, which is somewhat higher than that obtained in DBP-based trials.⁴ This diminution of cardiac events in SBP-based trials could reflect the choice of SBP as the specific enrolled criterion or the fact that these trials included only elderly subjects. Nevertheless, in the Hypertension Optimal Treatment (HOT) study,⁵ which was performed in middle-aged hypertensive subjects with systolic-diastolic hypertension, the failure to prove a benefit in terms of CV risk . . . [Full Text of this Article]

This article has been cited by other articles:

				F. H. Messerli and G. S. Panjrath The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? J. Am. Coll. Cardiol., November 10, 2009; 54(20): 1827 - 1834. [Abstract] [Full Text] [PDF]

				C. Avgeropoulou, A. Illmann, P.-M. Schumm-Draeger, J. Kallikazaros, and H. Von Bibra Assessment of arterio-ventricular coupling by tissue Doppler and wave intensity in type 2 diabetes The British Journal of Diabetes & Vascular Disease, November 1, 2006; 6(6): 271 - 278. [Abstract] [PDF]

				M. F. O'Rourke and J. B. Seward Central Arterial Pressure and Arterial Pressure Pulse: New Views Entering the Second Century After Korotkov Mayo Clin. Proc., August 1, 2006; 81(8): 1057 - 1068. [Abstract] [Full Text] [PDF]

				A. Harauma and T. Moriguchi Aged Garlic Extract Improves Blood Pressure in Spontaneously Hypertensive Rats More Safely than Raw Garlic, J. Nutr., March 1, 2006; 136(3): 769S - 773S. [Abstract] [Full Text] [PDF]

				J. M. Dijk, A. Algra, Y. van der Graaf, D. E. Grobbee, M. L. Bots, and on behalf of the SMART study group Carotid stiffness and the risk of new vascular events in patients with manifest cardiovascular disease. The SMART study Eur. Heart J., June 2, 2005; 26(12): 1213 - 1220. [Abstract] [Full Text] [PDF]

				H. H. Dao, R. Essalihi, C. Bouvet, and P. Moreau Evolution and modulation of age-related medial elastocalcinosis: Impact on large artery stiffness and isolated systolic hypertension Cardiovasc Res, May 1, 2005; 66(2): 307 - 317. [Abstract] [Full Text] [PDF]

				B. M. Egan, D. T. Lackland, and N. E. Cutler Awareness, Knowledge, and Attitudes of Older Americans About High Blood Pressure: Implications for Health Care Policy, Education, and Research Arch Intern Med, March 24, 2003; 163(6): 681 - 687. [Abstract] [Full Text] [PDF]

				C-K Wong and H D White Relation between blood pressure after an acute coronary event and subsequent cardiovascular risk Heart, December 1, 2002; 88(6): 555 - 558. [Full Text] [PDF]

				M. O'Rourke Target organ damage: use of pulse wave analysis as a manifestation of aortic degeneration in the assessment of hypertension Vascular Medicine, May 1, 2002; 7(2): 83 - 85. [PDF]

				S. Meaume, A. Benetos, O.F. Henry, A. Rudnichi, and M.E. Safar Aortic Pulse Wave Velocity Predicts Cardiovascular Mortality in Subjects >70 Years of Age Arterioscler Thromb Vasc Biol, December 1, 2001; 21(12): 2046 - 2050. [Abstract] [Full Text] [PDF]

				M. F. O'Rourke Diastolic heart failure, diastolic left ventricular dysfunction and exercise intolerance J. Am. Coll. Cardiol., September 1, 2001; 38(3): 803 - 805. [Full Text] [PDF]

				Age Affects How BP Indicators Relate to Heart Disease Risk Journal Watch Cardiology, May 4, 2001; 2001(504): 7 - 7. [Full Text]