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NDT Advance Access originally published online on September 9, 2005
Nephrology Dialysis Transplantation 2005 20(11):2301-2303; doi:10.1093/ndt/gfi092
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Editorial Comment

Efficacy of antihypertensive treatment: which endpoints should be considered?

Giuseppe Mancia and Guido Grassi

Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Centro Auxologico Italiano and Centro Interuniversitario di Fisiologia Clinica e Ipertensione, IRCCS Policlinico, Milano, Italy

Correspondence and offprint requests to: Prof. Giuseppe Mancia, Clinica Medica, Ospedale S. Gerardo dei Tintori, Via Donizetti 106, 20052, Monza, Milan, Italy. Email: giuseppe.mancia@unimib.it

Keywords: antihypertensive treatment; cardiovascular mortality

The first 150 words of the full text of this article appear below.



   Introduction
 
Knowledge on the benefit of antihypertensive treatment owes a great deal to antihypertensive drug trials based on incidence of morbidity and mortality [1]. These trials have demonstrated that antihypertensive drugs reduce cardiovascular morbid and fatal events of hypertensive individuals, counteracting their increased cardiovascular risk. They also demonstrated that this reduction occurs in males and females of different ages, ethnicities and clinical conditions and that thus the protection is virtually universal across the demographic and pathophysiological spectrum that characterizes an elevated blood pressure. They have finally demonstrated that drugs capable of lowering blood pressure protect hypertensive patients via sizes and designs that exclude even the remote possibility of ‘chance’ results as well as of errors due to selection bias, investigators’ and patients’ expectations, and inappropriate or unbalanced identification of events.

The above has generated the widespread opinion that information provided by morbidity/mortality trials is the most important one in . . . [Full Text of this Article]



   First limitation of clinical trials — selection bias
 


   Second limitation of clinical trials — ‘intention to treat’ analysis
 


   Third limitation of clinical trials — time and age scale
 


   Design of future clinical trials
 

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