WE BELIEVE we are now in an era in the empiric treatment of hypertension, when a huge uncontrolled clinical-pharmacological experiment may be masquerading as a clinically acceptable therapy.
There can be little doubt that the disabling and lethal agent in chronic hypertensive disease is not the blood pressure level but the associated arterial and arteriolar disease. Drug therapy, then, can be pursued seriously only by those who believe beyond question that cardiac, cerebral, renal, and retinal vascular disease is a direct consequence of elevated blood pressure. However, alternate possibilities do exist. Vascular disease and hypertension may stem from a single cause and represent different manifestations of the same disease; vascular disease may arise independently and the association be coincidental; vascular disease may precede and account for the hypertension; finally hypertension, arising independently, may accelerate the rate of progress of prior vascular disease. It is not possible at this time
Goldring W, Chasis H. Antihypertensive Drug TherapyAn Appraisal. Arch Intern Med. 1965;115(5):523–525. doi:10.1001/archinte.1960.03860170005002
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