An interesting essay by Pfeffer and McMurrary traces the recent history of trials of anti-hypertensive therapy. The authors chronicle the scientific evidence that has accumulated to show that treating hypertension lowers the risk of stroke, heart disease and death; that systolic blood pressure is very important; that outcomes are improved, even if the starting blood pressure is only slightly raised (particularly in diabetes); but that it is also possible to try too hard to control blood pressure. No mention here of salt, which is important in the genesis and maintenance of hypertension. However, this is a readable account of how the scientific and ‘social’ discovery of how to treat the ‘silent killer’ that is hypertension progressed hand in hand.
— Richard Lilford, CLAHRC WM Director
- Pfeffer MA, & McMurrary JJV. Lessons in Uncertainty and Humility – Clinical Trials Involving Hypertension. New Engl J Med. 2016; 375: 1756-66.