Managing
hypertension effectively requires careful evaluation of the patient, in particular for the presence of target-organ damage and of other risk factors for
atherosclerosis. Dietary management has proved to be unsatisfactory in most hypertensive patients, as patients resist
dietary restrictions or any other changes in life-style.
Drug treatment has been shown to significantly reduce morbidity and mortality in patients with diastolic blood pressures above 104 mm Hg. Evidence suggests that
drug treatment is also effective in those with diastolic pressures between 90 and 104 mm Hg. Selection of drugs is still an empirical decision--treatment with an oral
diuretic usually is effective for mild
hypertension (diastolic pressures 90
to 115 mm Hg). A sympathetic depressant, often
propranolol, may be added to the regimen next, and if this is ineffective, a
vasodilator (usually
hydralazine) is included. Common side effects of
antihypertensive drugs are seldom serious but can be annoying. Patients should be forewarned about them, and about the effects of untreated
hypertension in an effort to improve compliance.