Therapy of mild hypertension: an overview

The "push to treat" persons with mild hypertension in an effort to decrease cardiovascular risk and, ultimately, coronary mortality began even before data from clinical trials on the value of active treatment were published. Today, although active therapy has not been proved to be of value to all patients with mild hypertension, the impetus to prescribe drug therapy is even stronger. No drug is without risks; therefore, drug treatment is recommended only for those patients in whom the risk of disease--a risk that can be quantitated by careful risk assessment--outweighs the risk of therapy. This is especially important when the hazards of high-dose diuretic therapy, the first step in the widely used stepped-care approach, are considered. An alternative approach for selected patients with mild hypertension is first to prescribe 1 of the other available antihypertensive medications, such as alpha- or beta-blocking drugs along with moderation of dietary sodium. This approach is more conservative than that advocated by many authorities, but it is similar to the treatment proposed by an expert committee of the World Health Organization and the International Society of Hypertension.