Editorial Commentary Unresolved Issues in the Management of Hypertension

Elevated blood pressure (BP), along with tobacco use anddyslipidemia, is 1 of the 3 most important modifiable risk factors for cardiovascular disease (CVD).1 Over the last 4 decades there have been a series of epidemiological studies, clinical trials, and pathophysiologic investigations that have substantially enhanced our knowledge of the relationship of elevated BP to outcomes.2,3. In brief, the risk associated with elevated BP and coronary heart disease or stroke is continuous starting at110 mm Hg systolic in individuals with no previous CVD. BP lowering, per se, reduces CVD events, especially in those with systolic BP (SBP)160 mm Hg. A reduction in SBP by 10 mm Hg can lead to an 25 % relative risk reduction in coronary heart disease and a 35 % to 40 % relative risk reduction in stroke in trials of 5 years (which generally translates into2.5 years of intervention before an event).3 Reducing dietary sodium, increasing potassium, and reducin