Prevention and control of hypertension in New Zealand: a reappraisal.

A new national policy for the prevention and control of hypertension is required in New Zealand. The first priority is the prevention of hypertension with the development of a population strategy directed at encouraging healthy nutritional and exercise habits. Pharmacological management or specific nonpharmacological treatment of individuals is the second priority and decisions about treatment levels have important logistic and cost implications. Given the limited absolute benefits of treatment to individuals, the current policy of initiating treatment at a diastolic blood pressure of greater than or equal to 95 mmHg should be revised upwards. A population approach to the prevention of hypertension is essential in New Zealand because the majority (57%) of excess deaths due to raised blood pressure occur in people with diastolic blood pressure in the range 80-94 mmHg. A fall in the population mean diastolic blood pressure of 2 mmHg would have the same effect on total mortality rates as the successful treatment of everyone with a diastolic blood pressure greater than or equal to 100 mmHg. A national multidisciplinary group should be established to formulate strategies for preventing hypertension in New Zealand and to review current treatment guidelines.