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May 2, 1977

Treatment of High Blood Pressure

JAMA. 1977;237(18):1927. doi:10.1001/jama.1977.03270450017003

To the Editor.—  We have recently read "Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure," (237:255, 1977). The report as a whole is a commendable document, but it contains a number of scientific errors and omissions. The following suggestions are provided to reduce possible hazard to certain patients and to allow greater therapeutic efficacy on many occasions.In Step 1 of the "Stepped-Care Approach" section, the important therapeutic consideration that secondary hyperaldosteronism may lessen efficacy has not been mentioned. A concluding comment could be added to this section in a future edition of the report, to read as follows:The volume depletion produced by thiazide therapy may cause increased secretion of aldosterone, resulting in fluid and sodium retention and a lesser reduction in blood pressure. When secondary hyperaldosteronism is suspected of blunting antihypertensive efficacy in Step 1, the physician should consider adding an