Monotherapy in the treatment of hypertension

Approximately 600 people with mild to moderate hypertension were treated with a regimen that started with monotherapy. Reduction in sodium intake achieved adequate blood pressure control in 38 percent, higher than that achieved without therapy (17 percent). Chlorothiazide and propranolol gave satisfactory blood pressure control in 43 and 56 percent of patients, respectively, as sole therapy. When initial blood pressure was greater than 110 mm Hg, satisfactory control was achieved in fewer patients (sodium restriction, 13 percent; chlorothiazide, 30 percent, propranolol 38 percent); in this group, therapy with reduction of sodium intake alone is rarely effective. All measures were about equally successful in treating isolated systolic hypertension. The group given thiazide diuretics alone had an increased number of deaths from myocardial infarcts compared with other groups. This was not seen if a beta-blocking drug or a centrally-acting drug was used in conjunction with the thiazide diuretic. Monotherapy can successfully reduce blood pressure in most patients with mild hypertension. No regimen can be stated to be unequivocally superior to another.