The JNC 7 hypertension guidelines.

Abstract

To the Editor: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends that thiazide-type diuretics should be prescribed as initial therapy for most patients with hypertension. Although an extensive metaanalysis also concluded that diuretics are the most effective treatment for preventing morbidity and mortality in patients with hypertension, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found that patients receiving diuretic therapy had a higher incidence of hypokalemia, hyperglycemia, new-onset diabetes, and a more rapid decline in glomerular filtration rate compared with those receiving amlodipine or lisinopril. Furthermore, diureticinduced hyponatremia is not always a benign condition. Because treatment of hypertension is continuous and long term, physicians need to frequently assess the electrolyte and glucose levels as well as the renal function of patients receiving thiazide diuretics. The development of these metabolic changes may necessitate modification of diuretic therapy. In highlighting the benefits of diuretic treatment, I believe that JNC 7 report should have also issued guidelines and cautions for long-term management with diuretics.