Clinical trials of single-drug therapy for the cardiac effects of hypertension.

Much has been learned in epidemiologic studies and clinical trials about the relationships between hypertension and cardiac anatomic and functional responses, as well as the effects of antihypertensive treatment on those responses. The results of recent multicenter trials have supported initial concerns that not all drugs effective for blood pressure reduction are effective for reduction of LV mass and regression of LVH. However, recent trials of single-drug therapy suggest that those agents initially believed to be ineffective for LV mass reduction (principally diuretics and beta-blockers), on the basis of pathophysiologic theory and inadequate clinical trials, may in fact be quite effective for LVH regression, as well as for improving cardiac outcomes. Additionally, fears concerning the adverse effects of LV mass reduction on systolic and diastolic LV function have not been justified by the results of clinical trials. In conclusion, the often-assumed lack of efficacy of diuretics and beta-blockers for the reduction of LV mass can no longer be used as a reason to disregard the longstanding recommendations of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension supporting the use of diuretics and beta-blockers as the initial drug treatment of hypertension.