CLINICAL PROGRESS Clinical Evaluation of Antihypertensive Drugs

T HE evaluation of antihypertensive drugs has become a big business. Hundreds of people who work in some aspect of clinical investigation spend at least part of their time in this process. Their observations determine the expenditure, first by the drug companies and then by the public, of some millions of dollars a year. Even the law recognizes the fact that no accumulation of pharmacology, however sound, and no amount of promotion can do anything for a drug which has not had a reasonably adequate clinical trial. Everyone acknowledges that it is the crucial aspect determining drug sale. But so far no one has paid much attention to the definition of the term, "adequate" or the characterization of the proper means of study of an antihypertensive drug. This is partly because it is a new field of effort. Less than 10 years ago we used to plead with manufacturers to turn their attention to the field of antihypertensive medication. But, in a world in which the industrial emphasis was on antibacterials and vitamins, and with the medical profession apparently satisfied with garlic and phenobarbital, we got very little response. At long last, the commercial possibilities of a chronic and very common disease have been abundantly recognized and the dam has broken. The ensuing flood of drugs has taken most investigators by surprise, finding them without real agreement on technics and procedures. As a result, there is a great deal of repetition and of waste effort, and the investigator too often deserts his legitimate field of basic scientific study to spend his time in a