The Dilemma of 'Mild' Hypertension

Abstract

THE ISSUE of whether to treat "mild" hypertension is more controversial than the two articles 1,2 and one editorial 3 that were published in the Jan 21 issue of JAMA would lead the unsuspecting reader to believe. There are many who believe that the evidence favors the use of drug therapy to reduce diastolic BP when it is consistently above 90 mm Hg despite a three- to six-month trial of appropriate nonpharmacologic (eg, dietary) treatment. This issue is not an inconsequential academic controversy. The lives and well-being of more than 20 million Americans with mild hypertension are at risk. The Hypertension Detection and Follow-up Program (HDFP) data indicate that rigorous treatment of mild hypertension decreases the five-year mortality by 20.3% (from 7.4% in the referred care [RC] group to 5.9% in the stepped care [SC] group [ P 4 Even to concede Dr Pickering's "of or by" dilemma, a simple