CHOICE OF INITIAL THERAPY FOR HYPERTENSION

Hypertension is one of the most common conditions treated by the clini cian, yet accurate diagnosis and selection of the appropriate treatmen t can be challenging and recommendations regarding antihypertensive me dications continue to evolve. The fifth report of the Joint National C ommittee on Detection, Evaluation, and Treatment of High Blood Pressur e recommends diet and exercise for the initial treatment of mild hyper tension, followed by a diuretic or P-blocker if necessary, unless cont raindicated. This recommendation is based on outcome studies using the se drugs that demonstrate reductions in major diseases that treatment of hypertension is intended to prevent: stroke and cardiovascular morb idity and mortality. Other antihypertensive drugs, while not tested in large trials evaluating outcomes, have unique advantages for certain patients. Consideration of the patient's medical conditions and needs, including the cost of medication, is essential to ensuring optimal tr eatment of hypertension.