Long-term clinical trials in hypertension:

Long-term clinical trials of antihypertensive therapy have demonstrated that diuretic-based therapy consistently reduced fatal and non-fatal cerebrovascular events regardless of age, race or gender; the frequency of ECG left ventricular hypertrophy, retinopathy and progression of hypertension were also reduced, and cardiomegaly and ECG left ventricular hypertrophy were reversed. A case can be made for initiating antihypertensive therapy whenever diastolic blood pressure remains greater than or equal to 90 mmHg despite a fair trial of non-pharmacologic treatment. Elderly patients with diastolic hypertension benefit from diuretic-based therapy at least until the age of 80 years. Whether ACE inhibitors or calcium channel blockers are more effective than diuretics in preventing cardiovascular complications remains to be seen. So far, there have been no long-term trials using these agents as initial therapy.