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SPECIAL JAMA ON HYPERTENSION OFFERS NEW DATA, RECOMMENDATIONS.

A special issue of JAMA devoted to research, reviews, and editorial comment on hypertension offers interesting and important insights on this common medical problem.

One study describes changes in lipids associated with various antihypertensive regimens and concludes that weight loss with a fat-modified diet and exercise leads to improved lipid profiles, regardless of the agent used. Decreases in total and LDL cholesterol were greatest with doxazosin and acebutolol, and less with a diuretic.

Another study analyzed epidemiological data from Framingham, Massachusetts, and found that hypertension accounts for 39 percent of the cases of heart failure for men, and 59 percent for women. Survival at five years after the onset of hypertensive heart failure was only 24 percent for men and 31 percent for women.

A meta-analysis of trials on dietary sodium restriction concluded that this strategy might offer modest benefit for older hypertensive patients, but there was no evidence to support the use of sodium restriction for normotensive patients.

A review assessing the ideal first choices for treatment concluded that the recommendations for diuretics and beta- blockers are justified by outcome data. Other classes of drugs may be as good, but have not yet undergone the same scrutiny in large clinical trials.

Comment: Each of these studies addresses an important issue, and, together, they show the continued importance of hypertension and the lingering controversy surrounding several aspects of its treatment.

— TH Lee

Published in Journal Watch General Medicine June 21, 1996

Citation(s):

Special issue on hypertension. JAMA 1996 May 22 275 1549-1606.

• Medline abstract (Free)