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Therapy for hypertension. How much of what drug for whom?

WHICH hypertensive patients should be treated? How far should blood pressure be lowered? Which drugs should be used? Physicians have been offered answers to these questions in the recent recommendations of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. 1 The Committee, charged with determining who might benefit from antihypertensive therapy, has issued reasonable and practical recommendations based on its assessment of the benefits, risks, and cost of antihypertensive therapy. However, the Committee failed to distinguish between therapeutic recommendations that have produced beneficial results in actual clinical trials and recommendations that have not received such empirical validation. Whom to Treat? "Virtually all patients with diastolic pressures of 105 mm Hg or higher should be treated with antihypertensive drugs" because "drug treatment reduces morbidity and mortality in such patients." As evidence for this recommendation, the Joint National Committee cites the Veterans Administration Cooperative Study. 2 As