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Mild hypertension: MRC working party report

The results of further analysis of the Medical Research Council's trial of drug treatment of mild hypertension (4 June, p 1565) contain a major statement that is not reflected in the abstract or in the discussion: that mild hypertension with a sustained diastolic pressure of 90-109 mm Hg was not a significant risk factor for stroke or myocardial infarction for women aged 35-64. The abstract, however, implies that treatment of women will prevent stroke, and these statements are incompatible. There is also an inconsistency in the analysis of the number of strokes prevented in high risk male smokers aged 55-64 with high systolic pressure at entry. In the discussion four high risk patients are said to need treatment for five years to avoid one stroke. It is then stated that 100 men in the highest risk group observed without treatment for five years would be expected to suffer five strokes. This is a fivefold difference even assuming that treatment was completely successful in preventing stroke. It would be interesting to know how body mass index changed from being a significant risk factor in 1985 to making no significant contribution in 1988. I welcome the Medical Research Council's effort to produce clear guidelines but think that further clarification is needed.