Choice of initial therapy for hypertension

Hypertension is one of the most common conditions treated by the clinician, yet accurate diagnosis and selection of the appropriate treatment can be challenging and recommendations regarding antihypertensive medications continue to evolve. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure recommends diet and exercise for the initial treatment of mild hypertension, followed by a diuretic or β-blocker if necessary, unless contraindicated. This recommendation is based on outcome studies using these drugs that demonstrate reductions in major diseases that treatment of hypertension is intended to prevent: stroke and cardiovascular morbidity 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 treatment of hypertension.