MODERN STRATEGIES TO PREVENT CORONARY SEQUELAE AND STROKE IN HYPERTENSIVE PATIENTS DIFFER FROM THE JNC-V CONSENSUS GUIDELINES

In recent years, government agencies of many countries have establishe d consensus guidelines for the evaluation and treatment of hypertensio n. Once published, guidelines tend to be perceived as directives by a variety of health care providers. Unfortunately, these guidelines ofte n do not reflect the practices of most hypertension experts. This repo rt summarizes the opinions of seven hypertension experts concerning th e impact of ''official'' guidelines on clinical practice. In addition, the individual therapeutic recommendations of these panel members are summarized. Their different treatment strategies reflect the diversit y of first rate treatment plans that aim to reduce the cardiovascular sequelae in individual patients with essential hypertension. Most impo rtantly, not one of these seven treatment strategies followed the ''pr eferred'' treatment of the U.S, guidelines, which recommend diuretics and beta-blockers as first-line therapy. The present authors approach the treatment of hypertension as a means to reduce cardiovascular even ts, Thus, reduction of blood pressure is not the most important therap eutic endpoint. The panel believes that whereas many different drugs c an produce effective blood pressure reduction, the modern primary goal of antihypertensive drug therapy is to select a regimen most likely t o prolong the quality and duration of life. In real terms, this means that the primary goal of treatment is the prevention of the major vasc ular sequelae of hypertension (heart attack, ventricular remodeling, h ypertrophy, heart failure, and stroke) that shorten useful life. There are a number of effective hypertensive treatments, which can be selec ted based on individual patient requirements. However, many consensus guidelines do not allow the flexibility required to optimize individua l patient treatment. As a result, health care providers should not fee l compelled to regard the preferences of ''official'' guidelines as th e best, modern, state-of-the-art therapy for an individual patient. Al l seven experts who are deeply involved in the daily care of patients preferred drugs other than beta-blockers and diuretics (the Joint Nati onal Committee [JNC] choices) for first-line therapy of hypertension.