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April 19, 2000

Diuretics vs α-Blockers for Treatment of Hypertension: Lessons From ALLHAT

Author Affiliations

Author Affiliation: Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Mass.

JAMA. 2000;283(15):2013-2014. doi:10.1001/jama.283.15.2013

The "graying" of the population has increased the number of patients with hypertension, threatening these patients' quality and length of life. The challenge for physicians treating patients with hypertension is to normalize blood pressure effectively, with as few therapeutic misadventures and medication-related symptoms as possible, at the least possible cost.

Early in the development of antihypertensive agents, it was generally assumed that comparative trials of specific antihypertensive agents were unnecessary because treatments that lowered blood pressure equally were likely to yield equal clinical benefit. This belief led to the use of blood pressure as a surrogate marker and sufficient basis for approval for labeling drugs for use as antihypertensive agents.1 However, as new drugs were developed with very different mechanisms of action and adverse event profiles, this theory began to be reevaluated. In fact, it seems likely that certain groups of patients—such as those with diabetes, left ventricular dysfunction, angina pectoris, migraine, prostatism, or lipid disorders—may reap different advantages from different antihypertensive drug groups.2 This belief, in part, led to the suggestion in the "Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" that initial antihypertensive drug choices take into account the comorbid conditions of the patients being treated.3