Dr. O'Brien's article in the current issue is of interest because it permits a comparison of the British approach with the American methods of management of hypertension. There are many points of similarity. In both countries there is a trend away from time consuming and expensive diagnostic work-up for curable forms of hypertension. Also, the British, like us, are undecided on whether to treat patients with mild hypertension.
The striking differences between British methods of treatment and ours lie in the choice of drugs. The mainstays of our therapeutic armamentarium are the thiazide diuretics, reserpine, methyldopa, hydralazine hydrochloride, and guanethidine sulfate. Dr. O'Brien advocates the use of only two of these three agents, methyldopa and the thiazide diuretics. He has replaced the other drugs with new agents such as bethanidine, debrisoquine, and propranolol hydrochloride.
In this country, bethanidine and debrisoquine have not been approved for marketing. Although propranolol is available,
Freis ED. New Drugs for Hypertension. JAMA. 1974;229(6):689. doi:10.1001/jama.1974.03230440047033
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