Nm. Kaplan et Rw. Gifford, CHOICE OF INITIAL THERAPY FOR HYPERTENSION, JAMA, the journal of the American Medical Association, 275(20), 1996, pp. 1577-1580
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.