Fig. 2. Results of therapeutic trials [as described in 10] of hypertension: drug treatment tends to normalize DBP but not SBP. B = Before treatmen; T = under treatment. Acronyms of trials are indicated in reference 10.

some of whom were normotensive. Treated hypertensives compared to these controls presented a twofold increase in the risk ratio (RR) for CV mortality (RR 1.96; 95% confidence interval (CI) 1.74-2.22) and coronary mortality (RR 1.99; 95% CI 1.63-2.44). Adjustment for unmodifiable risk factors (height etc.) decreased the excess CV risk observed in treated subjects only slightly: RR 1.77; 95% CI 1.56-2.00 for CV mortality, and RR 1.76; 95% CI 1.44-2.16 for coronary mortality. After additional adjustment for modifiable associated CV risk factors (plasma glucose, cholesterol etc.), the increased mortality in treated subjects persisted: RR 1.52; 95% CI 1.33-1.74 for CV mortality, and RR 1.49; 95% CI 1.19-1.86 for coronary mortality. Only after additional adjustment for SBP were CV mortality and coronary mortality similar in the two groups of subjects: RR 1.06; 95% CI 0.92-1.23, and RR 1.06; 95% CI 0.85-1.35, respectively. Finally, such results indicated again that there is a need for a tight SBP control in treated hypertensive subjects.

Difference (reference minus experimental) in systolic pressure (mm Hg)

Difference (reference minus experimental) in systolic pressure (mm Hg)

Fig. 3. Meta-analysis of therapeutic trials [13]: odds ratios for CV mortality in relation to corresponding differences in SBP. Odds ratios were calculated for experimental versus reference treatment. BP differences were obtained by subtracting achieved levels in experimental groups from those in reference groups. Negative values indicate tighter BP on control than on reference treatment. The regression lines were plotted with 95% CI and were weighted for the inverse of the variance of the individual odds ratios. Open symbols denote placebo-controlled studies or trials with an untreated control group. Closed symbols indicate actively controlled trials. Acronyms of trials are explained in reference 13.

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