The benefits of antihypertensive therapy in reducing both cerebrovascular and cardiac events have been clearly demonstrated in the meta-analysis of randomised outcome trials. Whilst the use of diuretics and beta-blockers have tended to predominate in these trials, other agents were also included and thus it is reasonable to suggest that the benefit of treatment is not attributable to any particular class of agent but rather to a reduction in blood pressure per se. It may therefore, be reasonably argued that blood pressure itself is the only validated surrogate marker of cardiovascular outcome. In routine clinical practice evaluation has indicated that in treated hypertensives not only is blood pressure not lowered to normotensive levels but also that control of pressure was not consistent over a 24 hour period. Finally epidemiological evidence suggests that blood pressure control should be based upon treatment strategies that lower blood pressure to normotensive levels in a smooth and consistent fashion.
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