Partial Reduction of Blood Pressure and Prevention of Complications in Hypertension

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Abstract
The data obtained in the Veterans Administration Cooperative Study on patients with prerandomization diastolic blood pressures averaging 90 to 114 mm Hg were analyzed to ascertain the importance of reducing blood pressure to normal in prevention of major complications. Of 380 patients 186 were randomly assigned to active drug treatment. Blood pressures recorded at the visit four months after randomization were used to select two subgroups of treated patients: Subgroup A comprised 67 patients who exhibited diastolic blood pressures of 90 mm Hg or higher, whereas Subgroup B included 62 patients with diastolic levels of 80 mm Hg or less. Over an average follow-up period of 3.2 years cardiovascular complications developed in 14.9 per cent of Subgroup A and 9.7 per cent of Subgroup B. The attack rates in Subgroup A were significantly less (p<0.05) than the 28.9 per cent of patients in the untreated group in whom morbid events developed. The results suggest that although normalization of blood pressure with antihypertensive drugs is desirable, considerable therapeutic benefit is still obtained with lesser degrees of pressure reduction. (N Engl J Med 291:329–331, 1974)