I agree with so many of the points made in the letter by Drs Jabbour and Lown. Let me reiterate, the national effort to prevent, detect, and control hypertension is succeeding. However, viewed through the crosshairs, hypertension is a moving target, which is exactly one of our problems. Clinicians and public health workers need to set their sights on lower blood pressure goals, since the totality of science demonstrates the risk of elevated blood pressure and the benefits of therapy to lower thresholds. Now let me bring up another point. We will not be successful with the current paradigm of hypertension detection and treatment alone. There is no question that there are clear benefits of treating established hypertension, and we will work to have clinicians do more in this regard. But this strategy will not prevent all the blood pressure–related cardiovascular renal disease in populations. This is because blood pressure–related vascular complications occur prior to the onset of established hypertension. It has been known for quite some time that the blood pressure/cardiovascular disease risk relationship is continuous and progressive even below pressures of 140/90 mm Hg. This is why a population-wide approach is necessary, and the NHBPEP and the NHLBI have supported such a strategy and will continue to do so.
Lenfant C. Better Hypertension Control? Not Without Broad Interventions by Strong Public Health Institutions—Reply. Arch Intern Med. 2002;162(13):1530-1531. doi: