PubMed · 5634708
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A W Leishman, J L Thirkettle, B R Allen. 1968-01-13. Bethanidine in hypertension.. https://doi.org/10.1136/bmj.1.5584.120-c
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Ischaemic heart disease and myocardial infarction mortality rates have been steadily decreasing in many countries, since the late '60s in the USA, for example, and since the early '80s in Sweden. The decline in myocardial infarction mortality has been attributed both to improved treatment and to a decreased incidence. Analyses in the USA have suggested secondary preventive measures to contribute more to the decline in ischaemic heart disease mortality than formerly. Life-style modifications, acute intervention, and various well-documented pharmacological treatment options beneficially affect prognosis and survival. However, treatment is still suboptimal in many cases.
Until now, an occasional blood pressure of below 140 mmHg systolic and less than 90 mmHg diastolic at rest has been regarded as normal. However, the most recent recommendations set the range for normotension lower: below 130/85 mmHg. Therapeutic targets will have to be adjusted accordingly. Raised diastolic and/or systolic blood pressure accelerates the process of arteriosclerosis and causes baromechanical effects. These result in disturbances of organ perfusion (brain, heart, kidney, peripheral organs) and left ventricular hypertrophy, cardiac failure, haemorrhagic insult and hypertensive encephalopathy. Echocardiography is particularly well suited for revealing and quantifying the results of hypertension at an early stage. Prompt, adequate antihypertensive therapy prevents or decreases hypertension-induced organ damage. Early diagnosis of hypertension and consistent blood pressure normalisation are, therefore, indispensable. The proportion of undiagnosed and inadequately treated hypertension patients is too high, in fact it is clearly increasing. The author presents specific proposals for improving antihypertensive treatment in order to reduce or prevent avoidable hypertension-induced organ damage. Above all, society must heighten its awareness of health and sharpen its own sense of responsibility.