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Misconceptions and facts about treating hypertension.

DOI:10.1097/HCO.0000000000000194 The overall prevalence of hypertension is high and likely to further increase with aging, obesity and other risk factors. In fact, in the United States, the International Statistical Classification of Diseases and Related Health Problems code for hypertension is by far the most common single code used by practicing physicians. Although the benefits of antihypertensive therapy have been established by a solid bulk of evidence and rates of hypertension awareness, treatment and control have been improving over recent decades; they are still far from adequate. Moreover, several misconceptions persist among practicing clinicians, commonly in the areas in which evidence is scarce, misinterpreted or substituted by eminence. For instance, hydrochlorothiazide remains by far the most commonly prescribed antihypertensive agent in the United States and worldwide. Yet, as pointed out by Dr Wanpen Vongpatanasin (pp. 361– 365) in her provocative review, hydrochlorothiazide in itsusualdose of12.5 25 mgperdayhas neverbeen shown to reduce the risk of MI, stroke or death. Also, meta-analysis of clinical trials showed that, for any given difference in achieved clinic SBP, hydrochlorothiazide therapy was associated with 18% higher adverse cardiovascular events when compared with chlorthalidone. Clearly, therefore, chlorthalidone or indapamide should be preferred over hydrochlorothiazide in hypertensive patients whenever diuretics are required for the treatment of hypertension. Dr Steven G. Chrysant (pp. 383-390) tackles another common misconception, namely that antihypertensive therapy causes erectile dysfunction (ED). Indeed, erectile dysfunction is common in treated hypertensive men. However, as Dr Chrysant suggests, we have to ask whether the ED is due to hypertension per se, the antihypertensive regimen or a combination of both. Of note, data from randomized studies on ED and antihypertensive therapy are limited; as of today, the issue remains very much an evidence-free zone. It should not be forgotten that knowledge by the patient of the drug and its action on erectile dysfuction (ED) may increase the incidence of ED (Hawthorn’s effect). Dual renin angiotensin blockade was very much in fashion in the early part of this century;