Controversies in the management of hypertension.
Despite recent controversies in hypertension management, family physicians can confidently follow a straightforward diagnostic and treatment approach. Routine use of echocardiography or 24-hour ambulatory monitoring is not recommended in the initial work-up of hypertension. The optimum goal for the diastolic blood pressure remains at 80 to 85 mm Hg. As many as 20 to 25 percent of patients with mild hypertension become normotensive with dietary modifications, exercise and alcohol cessation. In patients with mild hypertension, these nonpharmacologic approaches should be tried for three to six months before drug therapy is instituted. Initial drug therapy should be chosen on the basis of effectiveness, ease of administration, tolerability, cost and long-term safety record. Many of the reported adverse metabolic effects of diuretics may be of limited clinical significance. Despite the availability of newer antihypertensives, diuretics remain a choice in most patients as initial therapy or as a step-2 drug.
Moser
M
M
Yale University School of Medicine, New Haven, Connecticut.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D008055:Lipids / Q000097:blood
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D004232:Diuretics; D008055:Lipids