You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
these are exciting times for physicians interested in the treatment of hypertension , with new and important data emerging regularly .
translating the excitement into better outcomes for large numbers of patients , however , means placing the new information in the hands of generalist physicians ( family physicians and general internists ) , and making the information clear enough to be usable rather than baffling .
hypertension practice guidelines should accomplish this information placement , but recent guidelines based on the most recent evidence reach conflicting conclusions in some ways .
the conflict centers around two key issues : does it matter how blood pressure is lowered ? ; and are there subsets of patients who benefit from antihypertensive drugs at lower pressures than we have conventionally believed , or who do not benefit unless pressures are higher than we have believed ? two recent trials offer what appears to be confusing guidance on the first question . stop-2   compared newer and older antihypertensive agents , and concluded that there were no substantial differences in outcomes among them . this finding lends credence to the conventional view that blood pressure is the factor that matters , and lowering it by any means that has acceptably low side effect rates is the appropriate approach .
not long after the publication of stop-2 , however , the doxazocin arm of the allhat trial was terminated because of an excessive rate of development of congestive heart failure compared with thiazides , suggesting that how blood pressure is lowered may indeed matter in terms of outcomes achieved . what is the primary care physician to make of these developments ?
it offers simplicity , and great flexibility in clinical choices : any treatment that reduces pressures and is acceptable to patients is a good treatment for hypertension .
it is tempting to think that the allhat findings may be an anomaly , or perhaps specific to doxazocin , and that the conclusion of stop-2 is the correct one .
it rather showed an excess of both myocardial infarction and congestive heart failure ( chf ) in the calcium antagonist arm as compared with the angiotensin - converting enzyme ( ace ) inhibitor arm , a finding attributed to chance due to the total of 48 such comparisons made .
the similarity of that finding to the results of the earlier appropriate blood pressure control in diabetes ( abcd ) trial , however , lends support to the argument that it was not a chance occurrence .
furthermore , an excess of myocardial infarction almost reached significance among the conventional - therapy arm compared with that of ace inhibitor .
conventional therapy in stop-2 involved thiazides and beta - blockers , and there is evidence from other studies that beta - blockers are not as effective , in terms of outcomes in the elderly , as thiazides .
the marked change in our understanding of chf over the past decade is worth considering in our thinking about hypertension .
the results of recent antihypertensive trials are exciting , rather than being confusing and dismaying , when seen in light of the chf research , and offer hope of getting closer to the real roots of the harm that hypertension does . a deeper understanding of the role of the renin - angiotensin - aldosterone system and the pathophysiological role of angiotensin ii in vascular disease , in particular , adds more credence to the view that pressure per se may not be all that , or even mostly what , matters for the hypertensive patient 's outcome .
antihypertensive drugs cause many effects other than lowering pressure , and those other effects are different for different classes . with the emergence of data demonstrating that ace inhibition improves cardiovascular outcomes in high - risk diabetics even without hypertension   and the established efficacy of beta - blockers for chf patients without hypertension , the role of humoral rather than merely mechanical factors in determining outcomes
if humoral factors matter as much as or more than pressure per se in determining outcomes of hypertension , we must focus our research on interventions that affect those humoral factors . but changing our thinking about how we treat will not be enough .
beta - blockade improves outcome among patients with coronary artery disease , regardless of hypertension , and , as already noted , ace inhibition also appears to do so for diabetics .
trials of what we regard as antihypertensive therapy could show improved outcomes among patients with high - normal or even normal pressures for reasons entirely unrelated to blood pressure , if the patients enrolled had significant baseline risks of cardiovascular disease .
we might erroneously conclude that our threshhold for diagnosing hypertension should be lowered , and mistakenly extrapolate those findings to all patients above our lowered thresholds .
so what do the findings of these most recent trials imply for the generalist physician ?
first and foremost , we can not assume that all antihypertensive drugs are created equal .
we should preferentially prescribe for our patients those that have demonstrated the best outcomes . at the present time , considering these outcomes , low - dose thiazides , beta - blockers , and ace inhibitors should be the mainstays of therapy .
we also need additional research : direct comparisons of different classes of agents in randomized non - placebo ( active control ) trials . those trials must compare real outcomes not blood pressures , and we must interpret those trials with care . at present , low - dose thiazides set the benchmark for outcome improvement among both elders with systolic hypertension and middle - aged patients with diastolic hypertension , and should be the active controls against which other agents are measured .
finally , and most importantly , we are moving further from a single decision criterion for deciding whom to treat .
primary care is a tough challenge , in which most patients have a number of health problems and concerns .
hypertension is only one player on the stage and , to the patient , it may not even have the starring role .
it was very helpful to have only one number , 140/90 , to remember amidst those many competing agendas and time pressures of the primary care visit .
we have just begun becoming comfortable with a different criterion for diabetics ; we must now begin looking at treating patients who are not hypertensive by any criterion , if their cardiovascular risks are high enough .
conversely , it may well not be worth treating some stage i hypertensive patients who are at such low risk that their potential absolute risk reduction from treatment is miniscule .
primary care physicians must shift their thinking to treating cardiovascular risks , rather than blood pressure numbers , and begin to develop the decision support models that allow this treatment in the busy , distracting , time - constrained context of primary care .
the publication of the results of the swedish trial in old patients with hypertension-2 ( stop-2 ) and the termination of the doxazocin arm of the antihypertensive and lipid lowering treatment to prevent heart attack ( allhat ) study again raise the question of whether all antihypertensives deliver equal cardiovascular outcome benefits . 
 data from research on congestive heart failure and from the heart outcomes prevention evaluation ( hope ) trial illuminate the roles and possible mechanisms of humoral mediators of vascular damage , suggesting , first , that some antihypertensives ( thiazides , beta - blockers , and angiotensin - converting enzyme inhibitors ) can deliver more improvement in outcomes than other agents and , second , that decisions on whom to treat are best made based on risk appraisal , not merely pressures .