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May 30, 1977

Control of Hypertension

JAMA. 1977;237(22):2378. doi:10.1001/jama.1977.03270490018003

To the Editor.—  I write in immediate reference to Dr Kochar's comments on hypertension screening (236:2551) but also regarding the larger issue of what is to be done with the newly found hypertensive person. Dr Kochar says, "For treatment of hypertension, a 'step care' approach is advised. Therapy in almost all instances begins with a diuretic."To a fairly freshly discovered hypertensive person such as myself, it seems that the first and most important therapeutic step in a steppedcare program has been missed in this review and seriously slighted in other reviews.1 This missed step is to work with the patient to change his or her life-style.In my own case, the change needed was to turn from an exceptionally sedentary life to regular daily exercise—swimming about one-half kilometer per day—coupled with some dietary self-restraint. These measures led to modest (6%) weight reduction but substantial blood pressure control (162/102