Cost-effective therapy for hypertension.

The costs of treating hypertension are out of control. The Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure and others recommend the use of diuretics and beta-blockers as first-line agents. Newer drugs such as calcium channel blockers, alpha-blockers, and angiotensin-converting-enzyme inhibitors have improved metabolic profiles, but have not been proved in long-term, randomized, controlled trials to reduce morbidity and mortality. Our General Medicine Clinic has gradually shifted toward prescribing the newer agents. We reviewed our drug use, evaluated the literature, and made recommendations in the form of guidelines. Clinicians' concerns included quality-of-life issues, sexual dysfunction, metabolic changes--lipids, potassium, insulin resistance--and others. These concerns were addressed, and a consensus was reached. Our goal is to streamline therapy, reduce costs, and provide proven effective medication.