MANY CLINICIANS consider a sufficiently high risk of stroke to be the clearest indication for pharmacological therapy of patients with mild to moderate hypertension. The rationale is derived from several recent overviews or meta-analyses of data from randomized trials. For stroke, there are clear reductions of about 40%, whereas for coronary heart disease (CHD), there are possible reductions of 9% to 14%.1-3 In those trials, the magnitude of the reduction in diastolic blood pressure (DBP) was 5 to 6 mm Hg, and the duration of treatment was about 3 to 5 years. In observational studies, such changes in DBP over longer periods are associated with about a 40% decrease in stroke but 20% to 25% reductions in risk of CHD.3,4
Several possible explanations have been offered for the smaller risk reductions in CHD observed in trials than predicted in observational studies. First, the beneficial effects on stroke may
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