We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Treatment of Mild Hypertension Study Final Results

James D. Neaton, PhD; Richard H. Grimm Jr, MD, PhD; Ronald J. Prineas, MB, PhD; Jeremiah Stamler, MD; Greg A. Grandits, MS; Patricia J. Elmer, PhD; Jeffrey A. Cutler, MD; John M. Flack, MD; James A. Schoenberger, MD; Robert McDonald, MD; Cora Elizabeth Lewis, MD, MSPH; Philip R. Liebson, MD; Janet Raines, MS, RD; Isabelle Joffrion, RN, MAE; Ralph E. Allen, PAC; Linda Jones, CRNP, MN; Deborah Parker; Jacqueline K. De Worth, MS, RD; Evelyn Anzelone; Doris Gunn; Ann George; JoAnn Montgomery; Gilberto S. Neri, MD; Eleanor Betz, RD; Barbara Mascitti, RD; Ellen Plank, RNNP; Brenda Peterson, RN; Tracy Remijas, MPH; Walter Washington; Irene Turner, MT; Laura Stefanie; Pamela Aye, MS, RD; Susan Madnek-Oxman, MS, RD; Helen Jones; Stephen R. Mascioli, MD, MPH; Nancy Van Heel, MS, RD; Cindy Bjerk, MS, RD; Fran Galle, RN; Patricia Laqua, RD; Margaret Miller, MT (ASCP); Liv Marit Bell, RN, MPH; Mary Ellen Robinson, MS, RD; Carolyn Thorson; Raymond Townsend, MD; Arlene Caggiula, PhD; Sinda Dianzumba, MD; Carole Ciak, RN, BSN; Marcella Link, MS, RD; Beth Hall, RD; Mary Monske, RN, BSN; Therese M. Theobald, BS, RDCS; Michelle Berry, MS, RD; Terry Coyne, MS, RD; Claire A. Bunker, PhD; Kaye Kramer, RN, BSN; Alain G. DuChene; Leslie A. Holland; Sylvia Tze, MS; Serena Sjolund; Cynthia A. Launer, MS; John Lagus, MS; Cynthia M. Miller; Kenneth H. Svendsen, MS; Arthur Leon, MD; Brian Laing, MS; Marsha McDonald, MA; Dean Surbey, MBA; Mary Kay Wiche, RD, MPH; Kimberly Kuiper; Richard Remington, PhD; Thomas J. Coates, PhD; Richard Devereux, MD; Ray W. Gifford Jr, MD; Herbert Langford, MD; Laurence McCullough, PhD; Herman A. Tyroler, MD
JAMA. 1993;270(6):713-724. doi:10.1001/jama.1993.03510060059034.
Text Size: A A A
Published online


Objective.  —To compare six antihypertensive interventions for the treatment of mild hypertension.

Design.  —Randomized, double-blind, placebo-controlled clinical trial.

Setting.  —Four hypertension screening and treatment centers in the United States.

Participants.  —Hypertensive men and women, aged 45 to 69 years, with diastolic blood pressure less than 100 mm Hg.

Intervention.  —Sustained nutritional-hygienic advice to all participants to reduce weight, dietary sodium intake, and alcohol intake, and increase physical activity. Participants were randomly allocated to take (1) placebo (n=234); (2) chlorthalidone (n=136); (3) acebutolol (n=132); (4) doxazosin mesylate (n=134); (5) amlodipine maleate (n=131); or (6) enalapril maleate (n=135).

Main Outcome Measures.  —Blood pressure, quality of life, side effects, blood lipid levels and analysis of other serum components, echocardiographic and electrocardiographic changes, and incidence of cardiovascular events over an average of 4.4 years of follow-up.

Results.  —Blood pressure reductions were sizable in all six groups, and were significantly greater for participants assigned to drug treatment than placebo ( — 15.9 vs — 9.1 mm Hg for systolic blood pressure and — 12.3 vs —8.6 mm Hg for diastolic blood pressure; p<.0001). After 4 years, 59% of participants assigned to placebo and 72% of participants given drug treatment continued on their initial medication as monotherapy. A smaller percentage of participants assigned to the drug-treatment groups died or experienced a major nonfatal cardiovascular event than those assigned to the placebo group (5.1% vs 7.3%; P=.21). After including other clinical events, the percentage of participants affected was 11.1% for those in the drug-treatment groups and 16.2% for those in the placebo group (P=.03). Incidence rates of most resting electrocardiographic abnormalities were lower and quality of life was improved more for those assigned to drug-treatment groups rather than the placebo group. Differences among the five drug treatments did not consistently favor one group in terms of regression of left ventricular mass, blood lipid levels, and other outcome measures.

Conclusions.  —As an initial regimen, drug treatment in combination with nutritional-hygienic intervention was more effective in preventing cardiovascular and other clinical events than was nutritional-hygienic treatment alone. Drug-treatment group differences were minimal. Pending results from large-scale clinical trials to evaluate drug treatments for their effect on cardiovascular clinical events, these findings support the recommendations of the new fifth Joint National Committee report regarding treatment choices for people with stage 1 ("mild") hypertension.(JAMA. 1993;270:713-724)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.