Controversy in the pharmacologic treatment of hypertension in African Americans

In 1993, the National Institutes of Health published the recommendations of the fifth, and most recent, US Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure. Many believe that this report advocates the use of inexpensive diuretics and beta-adrenergic-receptor blocking agents as first-line agents in the pharmacologic treatment of hypertension. It has been argued that this recommendation is engendered by primary concerns about costs rather than efficacy or patient satisfaction. The contrary view, however, contends that new, more expensive therapeutic drugs have not demonstrated long-term reductions in morbidity and mortality. For those who train physicians in the treatment of hypertension in African Americans, awareness of this dispute is pivotal so that informed decisions will be made by both the physician and patient.