The sixth report of the Joint National Committee on Prevention, Detect
ion, Evaluation, and Treatment of High Blood Pressure (JNC-VI) provide
s updated guidelines for the treatment of hypertension. Antihypertensi
ve drug therapy may be initiated either after a trial of lifestyle mod
ifications or immediately after the diagnosis is made, depending on th
e patient's other cardiovascular risk factors and the presence of clin
ical cardiovascular disease. In general, therapy may begin with diuret
ics or beta-adrenergic blockers in patients tinder age 65, unless a co
ncomitant condition warrants another, more tailored choice. Low dosage
s should be used initially, but if the blood pressure is not successfu
lly reduced to 140/90 mm Hg or below, another drug should be added or
should replace the initial choice. General principles of therapy inclu
de the use of once-a-day formulations and combination drugs as well as
cost considerations.