The Dilemma of 'Mild' Hypertension
Another Viewpoint of Treatment
- Ray W. Gifford Jr, MD;
- Nemat Borhani, MD;
- Iqbal Krishan, MD;
- Marvin Moser, MD;
- Robert I. Levy, MD;
- James A. Schoenberger, MD
- From the Department of Hypertension and Nephrology, The Cleveland Clinic Foundation (Dr Gifford); the Department of Community Health, University of California, Davis (Dr Borhani); The Mayo Clinic, Rochester, Minn (Dr Krishan); New York Medical College, Valhalla (Dr Moser); Columbia University, New York (Dr Levy); and the Department of Preventive Medicine, Rush-Presbyterian-St Luke's Medical Center, Chicago (Dr Schoenberger).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
Excerpt
THE ISSUE of whether to treat "mild" hypertension is more controversial than the two articles1,2 and one editorial3 that were published in the Jan 21 issue of JAMA would lead the unsuspecting reader to believe. There are many who believe that the evidence favors the use of drug therapy to reduce diastolic BP when it is consistently above 90 mm Hg despite a three- to six-month trial of appropriate nonpharmacologic (eg, dietary) treatment.
This issue is not an inconsequential academic controversy. The lives and well-being of more than 20 million Americans with mild hypertension are at risk. The Hypertension Detection and Follow-up Program (HDFP) data indicate that rigorous treatment of mild hypertension decreases the five-year mortality by 20.3% (from 7.4% in the referred care [RC] group to 5.9% in the stepped care [SC] group [P<.01]).4 Even to concede Dr Pickering's "of or by" dilemma, a simple
Footnotes
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Reprint requests to Department of Hypertension and Nephrology, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44106 (Dr Gifford).
