Hypertension is a chronic disease. Except in cases of malignant hypertension or extremely rapid increases in arterial pressure, the end-organ damage due to hypertension develops over a period of years. Long-term treatment is usually necessary before beneficial effects on morbidity and mortality can be demonstrated. While the benefit of acute reduction of blood pressure in patients with hypertensive crisis (severe hypertension associated with encephalopathy, papilledema, pulmonary edema, or acute renal failure) has been shown, no benefit from acute reduction of blood pressure in asymptomatic patients has been or is likely to be demonstrated. Acute reduction of moderately to severely elevated arterial pressure in asymptomatic patients is based on four assumptions: (1) that it is important to reduce blood pressure immediately; (2) that oral antihypertensive loading produces more rapid or improved control of blood pressure; (3) that initiation of maintenance therapy sustains the achieved reduction in blood pressure; and (4) that
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