Joint National Committee VI: individualized versus indiscriminate therapy for hypertension

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 beta-blocker since 1993. Practitioners 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.