The benefits of blood pressure reduction have been clearly established for diastolic
pressures of more than 100 mm Hg. For patients with a diastolic pressure between 90
and 99 mm Hg on repeated measurements, treatment should be initiated if other risk
factors are present—for example, a family history of coronary risk, increased cholesterol
level, male sex, smoking, or diabetes mellitus. When the pressure seems to be labile
or exaggerated in the office, home or ambulatory readings may provide confirmatory
information. For persons with diastolic pressures in the range of 90 to 94 mm Hg,
it may be suitable to initiate therapy with nonpharmacologic maneuvers such as sodium
restriction, weight reduction, and physical conditioning. In such cases, careful follow-up
of blood pressure is particularly important because it may increase later. The initial
therapy for mild hypertension should be selected to minimize adverse effects and should
be tailored to the individual patient. Management of all levels of hypertension must
be considered in light of the associated risk factors and a concomitant effort to
minimize cardiovascular risk.
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REFERENCES
- Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the Pooling Project.J Chronic Dis. 1978; 31: 201-306
- Hypertension in elderly patients.Ann Intern Med. 1989; 110: 901-915
- Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg.JAMA. 1970; 213: 1143-1152
- Relationship between cardiac output and peripheral resistance in borderline hypertension.Circulation. 1971; 43: 382-390
- Systemic and regional hemodynamics in low, normal and high cardiac output borderline hypertension.Circulation. 1978; 58: 441-448
- Borderline hypertension: relationship between age, hemodynamics and circulating catecholamines.Circulation. 1981; 64: 760-764
- Blood pressure load—a better determinant of hypertension.Mayo Clin Proc. 1988; 63: 1085-1091
- The effects of drug treatment for hypertension on morbidity and mortality from cardiovascular disease: a review of randomized controlled trials.Prog Cardiovasc Dis. 1986; 29: 99-118
- Electrocardiogram in evaluation of resistance to antihypertensive therapy.Arch Intern Med. 1977; 137: 1125-1129
- The prognostic value of ambulatory blood pressures.JAMA. 1983; 249: 2792-2798
- Multiple Risk Factor Intervention Trial: risk factor changes and mortality results.JAMA. 1982; 248: 1465-1477
- Treatment of mild hypertension: results of a ten-year intervention trial.Circ Res. 1977; 40: I98-I105
- Treatment of mild hypertension: a five year controlled drug trial; the Oslo study.Am J Med. 1980; 69: 725-732
- The Australian Therapeutic Trial in Mild Hypertension: report by the management committee.Lancet. 1980; 1: 1261-1267
- The effect of treatment on mortality in “mild” hypertension.N Engl J Med. 1982; 307: 976-980
- MRC trial of treatment of mild hypertension: principal results.Br Med J. 1985; 291: 97-104
- Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial.Lancet. 1985; 1: 1349-1354
- Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial.Am J Cardiol. 1985; 55: 1-15
- Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients: a double-blind controlled trial.Ann Intern Med. 1981; 94: 7-11
- Coronary morbidity and mortality, pre-existing silent coronary artery disease, and mild hypertension.Ann Intern Med. 1989; 110: 1017-1026
- Echocardiographically detected left ventricular hypertrophy: prevalence and risk factors; the Framingham heart study.Ann Intern Med. 1988; 108: 7-13
- The decline in ischemic heart disease mortality rates: an analysis of the comparative effects of medical interventions and changes in lifestyle.Ann Intern Med. 1984; 101: 825-836
- The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease.JAMA. 1984; 251: 351-364
- Cholesterol and mortality: 30 years of follow-up from the Framingham study.JAMA. 1987; 257: 2176-2180
- Effects of antihypertensive therapy on serum lipoproteins.Hypertension. 1983; 5: 120-131
- Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial.J Hypertens. 1987; 5: 561-572
- Increased absenteeism from work after detection and labeling of hypertensive patients.N Engl J Med. 1978; 299: 741-744
- Benefits and potential harm of lowering high blood pressure.Lancet. 1987; 1: 581-584
- The need to treat mild hypertension: misinterpretation of results from the Australian trial.JAMA. 1986; 256: 3134-3137
Article Info
Footnotes
Individual reprints of this article are not available. The entire Symposium on Hypertension will be available for purchase as a bound booklet from the Proceedings Circulation Office in February.
Identification
Copyright
© 1989 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
