The hypertensive patient in family practice

Hypertension is one of the commonest reasons for visits to family physicians. Left untreated, hypertension and its sequelae can lead to serious morbidity and mortality. Most hypertensive patients have essential hypertension.

MEDLINE and Index Medicus literature searches of original studies, meta-analyses, and clinical reviews were conducted for the years 1987 to the present to review the latest recommendations on the diagnosis and treatment of hypertension. Background information from articles written before 1987, accessed from cross-reference of the more recent articles, is occasionally cited.

Based on the reviewed literature, an approach to the diagnosis and treatment of hypertension for the family physician is presented with an emphasis on cost-effectiveness and nonpharmacologic treatment. Nonpharmacologic measures and lifestyle modification should always be part of the treatment plan, especially given the presence or risks of other comorbid conditions (i.e., diabetes and stroke). Coexisting conditions, side-effects, ease of adherence, cost of medication and monitoring, and anti-left ventricular hypertrophy properties should be considered in selecting a pharmaceutical agent to treat hypertension. Several areas of further research, particularly in the areas of cost-effectiveness and outcomes, are needed to refine further the treatment of hypertension.