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(Hypertension. 2007;49:e17.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Response to Target Blood Pressure Level Before Antihypertensive Class to Improve Outcomes More Quickly in Uncomplicated Hypertension

Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif

An extract of the first 250 words of the full text is provided, because this article has no abstract.

We appreciate Wexler’s¹ comments about the need for improvement in hypertension treatment in primary care settings. We agree that initiating treatment and adequately controlling blood pressure should be key objectives of primary care physicians. Our focus on patterns of drug selection in hypertension treatment did not intend to diminish the important implications of suboptimal treatment and control of elevated blood pressure. At the same time, appropriate medication choice may not only further the goal of blood pressure control but also achieve the goal of lowering the global risk for heart attack and stroke by ensuring that patients receive cost-effective medications with the best evidence of clinical efficacy. Current practices continue to deviate substantially from national recommendations.

Our analysis used 2 federally collected US national ambulatory care surveys to examine 1993–2004 trends in the prescription of antihypertensive drugs for uncomplicated hypertension. Thiazide diuretic prescriptions increased significantly immediately after the 2002 publication of main results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial demonstrated clinical equivalence or, in some cases, superiority of thiazide diuretics compared with calcium channel blockers and angiotensin-converting enzyme inhibitors.² Use of calcium channel blockers and angiotensin-converting enzyme inhibitors declined after the 1997 release of JNC-6 in which diuretics and ß-blockers were the recommended first-line drug therapies for uncomplicated hypertension.^3,4 These changes, however, seemed transitory, because prescribing patterns subsequently regressed toward their previous levels. This illustrates the difficulty involved in disseminating evidence-based practice, an issue not . . . [Full Text of this Article]