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(Hypertension. 2006;47:10.)
© 2006 American Heart Association, Inc.

Editorial Commentaries

Treatment of Hypertension

Remaining Issues After the Anglo-Scandinavian Cardiac Outcomes Trial

From the University of Texas Southwestern Medical Center, Dallas.

Correspondence to Norman M. Kaplan, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390. E-mail norman. kaplan@utsouthwestern.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
At least in hypertension, there has never been a perfect clinical trial. By its nature, hypertension poses several barriers to the performance and interpretation of even the most carefully planned and conducted therapeutic trial. First and perhaps foremost, blood pressure is a constantly moving target so that both the initial recognition of hypertension and its subsequent response to therapy are often difficult to validate. Certainly, the performance of only a few blood pressure measurements in an office setting usually provides blood pressure levels that are higher than multiple blood pressures taken out of the office.¹ Both automatic ambulatory measurements² and self-recorded home measurements³ have been found to be more predictive of future morbidity and mortality than office readings, but until now, all clinical trials have used a few office readings for identification of hypertension and quantification of therapeutic benefits. The inclusion of even many thousands of patients in a given trial does not erase the potential errors of the inherent variability in blood pressure that is often accentuated by the alerting reaction to office measurements. Moreover, even carefully selected meta-analyses may not cover the faults of incorrect data.⁴

A second barrier to the interpretation of trials that last 3 to 5 years, as most do, is the usual long duration of hypertension before overt target organ damage develops. It is obvious that the results of trials of limited duration may not provide a valid indication of the effects of therapy over the longer duration of the disease. Moreover, only mortality . . . [Full Text of this Article]