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April 11, 1994

What Patient With Essential Hypertension Should Receive Antihypertension Drug Therapy?

Author Affiliations

New York, NY

Arch Intern Med. 1994;154(7):824. doi:10.1001/archinte.1994.00420070154024

The natural history of essential hypertension has not been established, using acceptable statistical techniques, in terms of date of onset to complication and to death, which is surprising in that the disease is over 100 years old.

Treatment today is based on results of clinical trials that have a serious defect, ie, the basic assumption that both treated and control patients have the same disease. Since both origin and pathogenesis are unknown, conclusions drawn are suspect.1 Furthermore, essential hypertension includes two separate entities: high blood pressure and arteriosclerosis.

I compared the natural history of four patients whom I followed up from onset of their hypertension to death: Patient A, onset at age 31 years; died at age 70 years, with no previous morbidity; found dead seated in a chair after preparing husband's dinner. Patient B, onset at age 36 years to death at age 38 years from cerebral hemorrhage.

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