Pharmacologic management of hypertension. New guidelines based on latest studies

The fourth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure varies from the Committee's earlier reports in a number of ways. The introduction of additional effective antihypertensive agents with varying pharmacologic properties has undoubtedly stimulated the Joint National Committee to recommend a more flexible individualized approach to treatment. Diuretics, beta-adrenergic receptor blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers are all recommended as reasonable first-step agents in treatment of hypertension. The pharmacologic properties, cost, and side-effect profiles of these drugs differ considerably, and the effectiveness of certain agents appears to vary according to the patient's age and race. All these factors should be considered, as should the existence of any concomitant disease, in choosing initial treatment. Whatever drug is chosen, the physician must continue to provide careful follow-up to ensure that adequate blood pressure control is achieved with minimal side effects.