Stepped-care treatment of hypertension

The stepped-care approach to management of hypertension has proved effective for the majority of hypertensive patients. The use of diuretics as first-step therapy produces normotensive levels in as high a percentage of patients as any of the second-step drugs. Diuretics are easy to titrate and relatively inexpensive, and side effects are not generally serious. Beta blockers may be preferred in certain patients, who in many cases can be identified clinically without special testing. The use of small doses of a diuretic and a second-step agent, such as a beta blocker, may prove more efficacious and cause fewer side effects than larger doses of single agents.