The principal long-term aim in most patients is the prevention of stroke and myocardial infarction; reduction in the latter also requires attention to other risk factors such as smoking and plasma cholesterol. The more immediate aim of treatment is to reduce the blood pressure as near to normal as possible without causing symptomatic hypotension or otherwise impairing wellbeing (quality of life).
When this aim is achieved in severe cases there is great symptomatic improvement: retinopathy clears and vision improves; headaches are abolished. A variable amount of irreversible damage has often
29 The authors estimated that 5 years of statin treatment will prevent 100 major vascular events in every 1000 patients with previous myocardial infarction, or 70-80 events in patients with other forms of coronary heart disease or diabetes. There was no upper age limit to this benefit, and no lower limit to the level of LDL at which benefit was seen. Heart Protection Study Collaborative Group 2002 MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals. Lancet 360: 7-22.
been done by the high blood pressure before treatment is started; then renal failure may progress despite treatment, left ventricular hypertrophy may not fully reverse and arterial damage leads to ischaemic events (stroke and MI).
It is obviously desirable to start treatment before irreversible changes occur and in mild and moderately severe cases this usually means advising treatment for symptom-free people whose hypertension was revealed by screening.
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