A Dream Yet To Become True

Abstract

Modern antihypertensive agents banned the life threatening complications of malignant hypertension. Nevertheless, chronic treatment of arterial hypertension is still costly, tedious, and at the population level rather unsuccessful. Even more worrisome is the fact that pharmacological blood pressure normalization in hypertensive patients falls short of neutralizing the cardiovascular risk to the level of normotensive individuals. Given these shortcomings, either permanent cure or long-term prevention of arterial hypertension is desperately awaited. In this issue of Hypertension , Karin Skov and her coworkers present data from a well-conducted pharmacological study for the prevention of hypertension.1 The authors hypothesize that inhibition of the renin-angiotensin system in individuals with high familial risk may interfere with the self-accelerating process leading to the manifestation of hypertension. This study mimics the situation in young genetically hypertensive rats in which inhibitors of the system are known to delay the onset of the condition way beyond the active treatment period.2,3 The present trial studied 110 normotensive young adults in whom both parents had essential hypertension. Double blind treatment with either candesartan or placebo was conducted for 1 year followed by 24 months of no treatment in both arms of the trial. The authors report that the primary outcome, ie, the mean 24-hour ambulatory blood pressure, was not different between the 2 groups in the follow-up period, ie, when no active treatment was given in either arm of …