MANAGING THE CARDIOVASCULAR RISKS IN HYPERTENSION Introduction

The title of this conference, “Hypertension: A View Beyond the Numbers,” is not just an intriguing phrase, it is a meaningful concept. Those of us in the field of hypertension today know by now that antihypertensive treatment prevents complications and decreases morbidity. The classic study pointing to this conclusion was the Veterans Administration (VA) study, which clearly showed that morbidity was much greater among hypertensive patients who were not treated than among those who were. Two types of morbidity are associated with high blood pressure. One is the pressure-related set of complications, that is, those related to the level of the blood pressure at the time the complication occurs. These pressure-related complications are cerebral hemorrhage and congestive heart failure. Cerebral hemorrhage results when the pressure is so high in the blood vessels that the vessels burst; congestive heart failure develops when peripheral resistance is so high that it offers a major impediment to the function of the heart. The other set of complications arising from hypertension is related to the premature development of atherosclerosis. This is the area in which recent epidemiologic studies have uncovered some problems. Certainly, hypertension contributes to the premature development of atherosclerosis. However, treatment with antihypertensive medication has shown less influence on this complication of hypertension than on cerebral hemorrhage and congestive heart failure, the pressure-related events. This was one of the findings of the VA study. During a 4-year period, seven patients in the untreated group died of stroke and 14 had a nonfatal stroke; only one patient in the treated group died of stroke and only four had a