The treatment of hypertension.

Selection of Patients for Treatment ANY PATIENT who knows that he or she has a raised blood pressure requires treatment. For the majority, this will consist only of simple measures, e.g. weight reduction, reassurance and perhaps sedation to allay apprehension. However, the minority will require treatment with potent hypotensive drugs, and the selection of patients for such treatment remains difficult. Iln exercising such selection, two points are important: (a) once started, treatment with a potent drug will be required for the rest of the patient's life, except in a small proportion of those treated, and (b) the more time and care devoted by the doctor, and the more co-operative the patient, the better will be the results obtained. Within a very few years of the introduction of hexamethonium, the benefits of hypotensive therapy were clearly established. The side effects produced by ganglion-blocking agents were so severe, that their administration was virtually restricted to the treatment of the complications of hypertension. However, since the introduction of thiazides, adrenergic blocking agents, and methyldopa, it has been possiible to control hypertension with production of only minor side-effects from drug administration, so that the indications for treatment have broadened. This is demonstrated by Table 1, which illustrates the increasing proportion of patients referred to a clinic on account of a raised blood pressure, in whom treatment is started within the first three months after referral. This increase in the proportion of patients treated is partly due to the increasing appreciation of the prophylactic value of early blood pressure reduction, and partly to that of the value of thiazides used as a hypotensive agent. In my own series, the proportion of patients starting treatment with thiazides has risen from 25%/0 in 1957 and 1958, to 59% in 1964 (Table 2).