Our ideas about the management of hypertension have changed considerably in recent years. There is now general agreement that all patients with accelerated hypertension, as manifested by high diastolic pressure and Group III and IV funduscopic changes, should have their blood pressure reduced with antihypertensive agents. Differences of opinion still exist, however, in respect to the treatment of the less rapidly advancing types of hypertension. It is apparent that the life history of untreated essential hypertension varies widely from those patients whose lives are cut short in a matter of a few years, to those who survive to old age. The problem is further complicated because antihypertensive treatment is neither simple, innocuous, or inexpensive. If we are to approach a solution to this problem we need to know the answers to two questions. The first is: Does antihypertensive treatment prevent the organic complications associated with hypertension? and the second, How can we recognize and differentiate the patient who will develop serious complications from the patient who will live out a normal span of life
