Continued advances in antihypertensive therapy

Treatment of hypertension with diuretics and adrenergic inhibitors according to a stepped-care approach has been found to reduce the incidence of stroke but to have an insignificant effect on the occurrence of coronary heart disease. The availability of the calcium-channel-blocking agents and angiotensin-converting-enzyme inhibitors led to their inclusion as choices for initial monotherapy in the 1988 report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure, which stressed that hypertension be controlled with the fewest possible drugs at the lowest effective doses. Monotherapy for hypertension generally results in a lower cost, fewer side effects, fewer drug interactions, and greater patient compliance. The use of once-daily sustained-release verapamil at a dose of 180 mg is an example of the successful application of this newer approach to the treatment of mild-to-moderate hypertension.