Sound Clinical Advice for Hypertensive Patients
- Adrenergic β-antagonists
- Hypertension
- Antihypertensive agents
- Diet, sodium-restricted
- Angiotensin-converting enzyme inhibitors
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 enzyme inhibitors and diuretics) are beneficial therapeutic approaches for hypertensive adults with diabetes (2).
In addition to pharmacologic advice, this issue features an important report from Vollmer and colleagues (3) regarding a long-debated lifestyle intervention: dietary salt restriction. These investigators studied 412 adults who had systolic blood pressures of 120 to 160 mm Hg and diastolic blood pressures of 80 to 95 mm Hg. The adults were randomly assigned to either a typical U.S. diet or a Dietary Approaches to Stop Hypertension (DASH) diet that emphasized fruits, vegetables, low-fat dairy foods, whole grains, poultry, and fish. All food, including snacks and cooked meals, were provided as part of the study. Participants ate their assigned diet for 90 days (three consecutive 30-day feeding periods). During the 90 days, they were randomly assigned to varied sodium intakes of 3.5 g, 2.3 g, or 1.2 g for each 30-day feeding period.
Both the DASH diet and salt restriction lowered blood pressure compared with the typical U.S. diet and normal salt intake (that is, 3.5 g of sodium). The DASH diet combined with salt restriction lowered blood pressure more than either approach alone, and …
This 100-word excerpt has been provided in the absence of an abstract.
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