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January 27, 1975

Extensive Hypertensive Work-upIn Rebuttal to Dr. Finnerty

Author Affiliations

From the Section of Endocrinology and Metabolism, Department of Medicine, Boston University School of Medicine, Evans Department of Clinical Research, University Hospital, Boston.

JAMA. 1975;231(4):404. doi:10.1001/jama.1975.03240160066033

IT IS of considerable interest that Finnerty and I reached our differing conclusions regarding the extent of work-up necessary for the hypertensive patient from essentially the same data. The differing conclusions, I believe, result in large part from an epidemiologic- or public health-oriented approach to patient care, on the one hand, and a more traditional concept of the physician-patient relationship on the other.

There is logic in the therapeutic approach advocated by Finnerty, and it is possible that curable secondary hypertension might be recognized during long-term therapy. Furthermore, it is possible to recognize volume-dependent hypertension on the basis of response to diuretic therapy alone.

If one accepts (as do Finnerty and Gifford) that curable secondary hypertension accounts for 6% of the hypertensive population, this still amounts to an incidence of more than 1.3 million patients with remediable disease. If one adds to this population those patients with imbalances of the