The treatment of mild hypertension study

To the Editor.—The Treatment of Mild Hypertension Study (TOMHS)1represents a worthy contribution to the evaluation of therapeutic interventions on outcomes in patients with mild hypertension. The use of broad categories of morbidity and mortality outcomes demonstrated the overall benefit of antihypertensive agents plus lifestyle modification compared with lifestyle modification alone. Blood pressure reductions with all five antihypertensive agents (acebutolol, amlodipine maleate, chlorthalidone, doxazosin mesylate, and enalapril maleate) plus lifestyle modification were significantly greater than with lifestyle modification alone for "all follow-up BP [blood pressure] measurements." The significance of blood pressure reduction was also addressed in the accompanying Editorial2stating, "All classes of drugs, with the exception of the angiotensin-converting enzyme inhibitor (enalapril), were equally effective in lowering blood pressure in TOMHS and all were superior to the lifestyle-modification regimen given with placebo." Clarification of this statement is needed because the drug dosages evaluated in TOMHS were