The Most Important Goal with Hypertension Is to Lower Blood

The sixth report of the Joint National Committee on the prevention, detection, evaluation, and treatment of high blood pressure (JNC-VI) states that diuretics or beta-blockers (BB) should be the drugs of choice when initiating treatment of uncomplicated hypertension.1 In contrast, the report of the World Health Organization and the International Society of Hypertension (WHOISH) does not express a preference in the choice of the initial treatment, indicating that all available drugs could constitute a suitable therapeutic alternative.2 The question of great importance is whether the new drugs (calcium antagonists [CA], angiotensin converting enzyme [ACE] inhibitors and angiotensin II receptor antagonists [ARA II]) provide as good or better prognosis for hypertensive patients compared to diuretics and BB. A range of studies have compared the benefit of antihypertensive treatment with diuretics and/or BB with a strategy based on CA, ACE inhibitor and ARA II. The CAPPP (ACE inhibitor vs BB/diuretics),3 INSIGHT (nifedipine GITS vs hydrochlorothiazide and amilozide),4 NORDIL (diltiazem vs BB/diuretics)5 and STOP-2 (ACE inhibitor vs dihydropyridine CA vs BB/diuretics)6 studies are the main clinical trials that have analyzed the influence of these different therapeutic interventions on prognosis. No significant differences were observed in the primary outcomes, suggesting the most important goal in the treatment of hypertension is to lower blood pressure. The agent used to achieve this goal is of secondary importance. This conclusion has been refined in a number of ways. For ED I TO R I A L S