Traditional First-Line Therapy Overview of Medical Benefits and Side Effects

When diuretic-based stepped care was first advocated for the treatment of hypertension, there were fewer classes of antihypertensive medication than there are today. In 1984, the third Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC) for the first time suggested an alternative initial treatment with a β-blocker in selected hypertensive patients, and the fourth JNC report has recommended the alternatives of calcium channel blockers or angiotensin converting enzyme inhibitors for step-one therapy as well. However, only the diuretic drugs and β-blockers have been shown to reduce cardiovascular morbidity and mortality in prospective, long-term, controlled trials. Moreover, 30 yearsʼ experience with diuretic agents and 20 yearsʼ experience with β-blockers have defined the advantages, disadvantages, and potential side effects of these drugs more precisely than is possible for newer agents. The diuretic drugs and β-blockers remain excellent choices in the management of hypertension.