Current Hypertension Reports

, Volume 2, Issue 3, pp 243–246 | Cite as

Joint national committee VI: Individualized versus indiscriminate therapy for hypertension

  • Charles P. Tifft

Abstract

The treatment of hypertension has progressed from a few nontoxic choices to the close to 60 individual drugs listed in the recommendations of the Sixth Report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Many combination drugs are also listed for use. The JNC documents have suggested initial therapy with diuretic or b-blocker since 1993. Practioners have followed these suggestions or not followed them on the basis of their personal bias. Since the 1997 JNC VI report, several studies that seem to support an individualistic approach to treatment have been reported. This is an exciting time in hypertension research. Clinicians who treat this common disorder will continue to line up as indiscriminate or individualistic prescribers, depending on their interpretation of the available data. We expect the hypertensive patient to be the winner of this increased attention.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997, 157:2413–2446.CrossRefGoogle Scholar
  2. 2.
    Burt VL, Whelton P, Rocella E, et al.: Prevalence of hypertension in the US adult population: results from The Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995, 25:305–313.PubMedGoogle Scholar
  3. 3.
    Berlowitz DR, Ash AS, Hickey EC, et al.: Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998, 339:1957–1963. Provider noncompliance is more complex than avoidance of dose titration. This study in a Veterans Affairs population points out the need for continued reassessment of our management of each hypertensive patient.PubMedCrossRefGoogle Scholar
  4. 4.
    Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The Fifth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1993, 153:154–183.CrossRefGoogle Scholar
  5. 5.
    Curb JD, Pressel SL, Cutler JA, et al.: Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. JAMA 1996, 276:1886–92. This article has helped dispel the belief that diuretics are dangerous for diabetic patients.PubMedCrossRefGoogle Scholar
  6. 6.
    Grossman E, Messerli FH, Golbourt U: Does diuretic therapy increase the risk of renal cell carcinoma? Am J Cardiol 1999, 83:1090–1093.PubMedCrossRefGoogle Scholar
  7. 7.
    Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The 1988 Report of the Joint National Committee on Prevention Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1988, 148:1023–1038.CrossRefGoogle Scholar
  8. 8.
    The Treatment of Mild Hypertension Study Group: The Treatment of Mild Hypertension Study: a randomized, placebocontrolled trial of a nutritional-hygienic regimen along with various drug monotherapies. Arch Intern Med 1991, 151:1413–1422.CrossRefGoogle Scholar
  9. 9.
    Medical Research Council Working Party: MRC trial of treatment of mild hypertension: principal results. BMJ (Clin Res Ed) 1985, 291:97–104.CrossRefGoogle Scholar
  10. 10.
    Hansson L, Lindholm LH, Niskanen L, et al.: Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999, 353:611–616. This study is the first to compare b-blocker and ACE inhibitor. It suggests that both are appropriate for cardiac protection in hypertensive patients. This finding is supported by the UK Prospective Diabetes Study Group’s similar finding [12].PubMedCrossRefGoogle Scholar
  11. 11.
    Messerli FH, Grossman E, Golbourt U: Are beta-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review. JAMA 1998, 279:1903–1907.PubMedCrossRefGoogle Scholar
  12. 12.
    UK Prospective Diabetes Study Group: Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 39. BMJ 1998, 317:713–720.Google Scholar
  13. 13.
    UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. BMJ 1998, 317:703–713.Google Scholar
  14. 14.
    Wang JG, Staessen JA, Gong L, et al.:Chinese trial on isolated systolic hypertension in the elderly. Systolic Hypertension in China (Syst-China) Collaborative Group. Arch Intern Med 2000, 160:211–220. Another study suggesting that initial therapy with dihydropyridine may not be as risky as previously thought.PubMedCrossRefGoogle Scholar
  15. 15.
    Staessen JA, Fagard R, Thijs L, et al.: Randomised doubleblind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997, 350:757–764.PubMedCrossRefGoogle Scholar
  16. 16.
    Tuomilehto J, Rastenyte D, Birkenhager WH, et al.: Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999, 340:677–684.PubMedCrossRefGoogle Scholar
  17. 17.
    Hansson L, Zachetti A, Carruthers SG, et al.: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998, 351:1755–1762. Reversed stepped-care works, is tolerated, and is not associated with increased risk as blood pressure is lowered to less than 80 mm Hg diastolic.PubMedCrossRefGoogle Scholar
  18. 18.
    Dahlof B, Hansson L, Lindholm L, et al.: STOP-Hypertension-2: A prospective intervention trial of ‘newer’ versus ‘older’ treatment alternatives in old patients with hypertension. Blood Pres 1993, 2:136–141.Google Scholar
  19. 19.
    The Heart Outcomes Prevention Evaluation Study Investigators: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high risk patients. N Engl J Med 2000, 342:145–153. The use of ramipril was beneficial, even in normotensive patients. Is this drug class or this medication special?CrossRefGoogle Scholar
  20. 20.
    Cashin-Hemphil L, Holmvang G, Chan RC: Angiotensin-converting enzyme inhibition as antiatherosclerotic therapy: no answer yet. QUIET Investigators. Quinapril Ischemic Event Trial. Am J Cardiol 1999, 83:43–47.CrossRefGoogle Scholar
  21. 21.
    Burnett JC: Vasopeptidase inhibition: a new concept in blood pressure management. J Hypertens 1999, 17(suppl 1):S37-S43.Google Scholar
  22. 22.
    Materson BJ, Reda DJ, Cushman WC, et al.: Single drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. Veterans Affairs Cooperative Study Group on Antihypertensive Agents [Corrected in Am J Hypertens. 1995, 8:189-192]. N Engl J Med 1993, 328:914–921.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • Charles P. Tifft
    • 1
  1. 1.Medical Care AffiliatesBostonUSA

Personalised recommendations