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January 25, 1993

National High Blood Pressure Education Program Working Group Report on Primary Prevention of Hypertension

Arch Intern Med. 1993;153(2):186-208. doi:10.1001/archinte.1993.00410020042003

IN THE United States and most other societies, blood pressure and the prevalence of high blood pressure rise progressively with increasing age. High blood pressure is among the most common and most important of the risk factors for cardiovascular-renal disease. To date, blood pressure— related risk reduction efforts have almost uniformly revolved around the paradigm of hypertension detection and treatment. Despite the clear benefits of treating established hypertension, this approach alone will not prevent all of the blood pressure— related cardiovascular-renal disease in the community. Blood pressure—related vascular complications can occur before the onset of established hypertension because the blood pressure—cardiovascular disease risk relationship is continuous and progressive, even within the normotensive blood pressure range. Furthermore, it is difficult to ensure that all hypertensive persons are detected and treated adequately. In addition, many hypertensive treatment regimens are expensive, especially those including new drugs, and almost all carry the potential for