Selecting antihypertensive drug therapy: the JNC-V controversy

To present both the supporting and the opposing arguments for the fifth set of recommendations issued by the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC).

The published studies are reviewed, and the various opinions are discussed.

The 1993 recommendation from the JNC that diuretics or beta-adrenergic blockers be preferred for therapy in most patients with hypertension has proved controversial. This recommendation derived primarily from recent long-term studies showing convincing reductions in cardiovascular morbidity and mortality when these agents are used to control hypertension. Comparable data have not yet been obtained for newer agents, such as calcium channel blockers and angiotensin-converting enzyme inhibitors. Nonetheless, some critics of the JNC recommendation still favor the newer agents because of their putatively superior side-effect profile, from both a metabolic and a compliance standpoint.

The issue of optimal antihypertensive drug therapy will not be definitively resolved until long-term studies directly comparing the various classes of agents are completed in future years.