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To the Editor.—Experienced physicians may be unenthusiastic about the Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) recommendations for treatment of hypertension for reasons not addressed by Drs Siegel and Lopez.¹ -Blockers significantly impair quality of life for many patients. For instance, if a husband neglects to mention his drug-related impotence to a physician, his wife might do so. Lethargy, constipation, and bronchospasm are common enough adverse effects to engender reluctance among physicians to burden patients with -blockers. Except for dry cough in some patients, angiotensin-converting enzyme inhibitors are remarkably free of adverse effects, and, in addition to their antihypertensive actions, may improve left ventricular function and may reduce the risk and severity of diabetic nephropathy.²

The use of combined hydrochlorothiazide with triamterene preparations reduces the need for potassium supplementation and for frequent electrolyte measurements. Costs of laboratory tests and potassium . . . [Full Text of this Article]

David Siegel, MD, MPH; Julio Lopez, PharmD
Department of Veterans Affairs
Northern California Health Care System
Martinez