Sound Clinical Advice for Hypertensive Patients
Authors: Cynthia Mulrow
Journal: Annals of Internal Medicine (2001)

Editorials18 December 2001Sound Clinical Advice for Hypertensive PatientsCynthia Mulrow, MD, MScCynthia Mulrow, MD, MScDeputy EditorSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-12-200112180-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, two perspectives highlight recent evolutions of thought regarding pharmacologic treatment for people with hypertension (1, 2). Furberg and associates remind us that “antihypertensive” drugs have multiple physiologic and clinical effects, some of which are independent of effects on blood pressure. Because blood pressure has limited value as a surrogate marker for clinical effects, it is not optimal to test, select, or approve drugs based solely on their efficacy in lowering blood pressure (1). Kaplan summarizes clinical trial evidence that shows that both blood pressure lowering (to a target <130/80 mm Hg) and therapy with specific agents (angiotensin-converting ...References1. Furberg CD, Psaty BM, Pahor M, Alderman MH. Clinical implications of recent findings from the Antihypertensive and Lipid-Lowering Treatment To Prevent Heart Attack Trial (ALLHAT) and other studies of hypertension. Ann Intern Med. 2001;135:1074-8. LinkGoogle Scholar2. Kaplan NM. The management of hypertension in patients with type 2 diabetes mellitus: guidelines based on current evidence. Ann Intern Med. 2001;135:1079-83. LinkGoogle Scholar3. Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG, et al . Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-Sodium Trial. Ann Intern Med. 2001;135:1019-28. LinkGoogle Scholar4. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al . Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344:3-10. [PMID: 11136953] CrossrefMedlineGoogle Scholar5. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al . AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284-99. [PMID: 11056107] CrossrefMedlineGoogle Scholar6. . The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med. 1997;157:2413-46. [PMID: 9385294] CrossrefMedlineGoogle Scholar7. Fodor JG, Whitmore B, Leenen F, Larochelle P. Lifestyle modifications to prevent and control hypertension. 5. Recommendations on dietary salt. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999;160:S29-34. [PMID: 10333851] MedlineGoogle Scholar8. Midgley JP, Matthew AG, Greenwood CM, Logan AG. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized, controlled trials. JAMA. 1996;275:1590-7. [PMID: 8622251] CrossrefMedlineGoogle Scholar9. Cutler JA, Follmann D, Allender PS. Randomized trials of sodium reduction: an overview. Am J Clin Nutr. 1997;65:643S-651S. [PMID: 9022560] CrossrefMedlineGoogle Scholar10. Graudal NA, Galløe AM, Garred P. Effects of sodium restriction on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride: a meta-analysis. JAMA. 1998;279:1383-91. [PMID: 9582047] CrossrefMedlineGoogle Scholar11. Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH, Kostis JB, et al . Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized, controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA. 1998;279:839-46. [PMID: 9515998] CrossrefMedlineGoogle Scholar12. Neaton JD, Grimm RH, Prineas RJ, Stamler J, Grandits GA, Elmer PJ, et al . Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA. 1993;270:713-24. [PMID: 8336373] CrossrefMedlineGoogle Scholar13. Taubes G. The (political) science of salt. Science. 1998;281:898-901, 903-7. [PMID: 9722464] CrossrefMedlineGoogle Scholar14. Alderman MH, Madhavan S, Cohen H, Sealey JE, Laragh JH. Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men. Hypertension. 1995;25:1144-52. [PMID: 7768554] CrossrefMedlineGoogle Scholar15. Mulrow CD. Evidence-Based Hypertension. London: BMJ Books; 2001. Google Scholar16. Ness AR, Powles JW. Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol. 1997;26:1-13. [PMID: 9126498] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Cynthia Mulrow, MD, MScAffiliations: Deputy EditorDisclaimer: In the past 3 years, Dr. Mulrow served as a site investigator of a multicenter hypertension trial funded by a pharmaceutical agency. She has not received honoraria or funds to attend conferences from pharmaceutical agencies in the past 3 years.Current Author Address: Cynthia Mulrow, MD, MSc, Department of Medicine, Mail Code 7879, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffects of Diet and Sodium Intake on Blood Pressure: Subgroup Analysis of the DASH-Sodium Trial William M. Vollmer , Frank M. Sacks , Jamy Ard , Lawrence J. Appel , George A. Bray , Denise G. Simons-Morton , Paul R. Conlin , Laura P. Svetkey , Thomas P. Erlinger , Thomas J. Moore , and Njeri Karanja , for the DASH-Sodium Trial Collaborative Research GroupClinical Implications of Recent Findings from the Antihypertensive and Lipid-Lowering Treatment To Prevent Heart Attack Trial (ALLHAT) and Other Studies of Hypertension Curt D. Furberg , Bruce M. Psaty , Marco Pahor , and Michael H. Alderman Management of Hypertension in Patients with Type 2 Diabetes Mellitus: Guidelines Based on Current Evidence Norman M. Kaplan Metrics Cited byHypertension therapy: Mixing, matching, and meeting targets 18 December 2001Volume 135, Issue 12Page: 1084-1086KeywordsAntihypertensive drug therapyBiomarkersBlood pressureDietEatingFoodHypertensionSaltsSodiumSodium chloride ePublished: 18 December 2001 Issue Published: 18 December 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...