Marc Pfeffer, M.D., Ph.D., Explains How Hypertension Standards Changed over Time
So it’s easy to have a risk but the real question is modifiable. For that we thank the Veterans Cooperative Studies, really the first major outcome studies in cardiovascular medicine with the use the randomized controlled trial and they tested three antihypertensives a combination against placebo in patients with a markedly elevated diastolic blood pressure and showed that you’d rather be on antihypertensives. They actually did two trials but there it was the information was out there in 1969, 1972. But what happened? The medical community and the public didn’t jump all over this. Oh, it was just men. It was a combination. These drugs are hard to take. It was severe hypertension. So really, despite this finding, people weren’t being treated. Interesting. So it’s not just the study but it’s how the study is taken up. So the fact that this wasn’t adapted by the community really meant that the trials as important as they were, as they came out, didn’t influence public health. Then we started hearing terms like “the silent killer.” Hypretension. You don’t feel better when you take the medications, but you should take the medications and the proof kept coming and coming and coming. Many governments — the British government, the Scandinavians — all came in with this: treat hypertension. Then a switch from diastolic, which is what the early, early studies to systolic came somewhere in the 1990s with the Systolic Hypertension in the Elderly trial and this really created that you don’t just need an elevated diastolic — as a matter of fact, most people today the elevation is in systolic — showed the benefit of lowering systolic. So our article really gives the history, which I’m not going to go into here, but does show how standards change and standards change based on what is being done in the community and what the trial has proposed. So our article was about humility, was about changes over time, and things do change. The trial is to take the best data we have to influence practitioners and patients for public health.