The Trial of Antihypertensive Interventions and Management is a multicenter randomized trial designed to examine the diastolic blood pressure response of various combinations of pharmacological and dietary interventions in the treatment of mild hypertension (diastolic blood pressure 90-100 mm Hg). Eight hundred and seventy-eight participants at 110-160% of ideal weight were randomly allocated to nine drug/diet treatment groups receiving either a placebo, chlorthalidone (25 mg), or atenolol (50 mg), combined with a usual, a weight loss, or a low sodium/high potassium diet The primary outcome was diastolic blood pressure change from baseline to 6 months. Seven hundred and eighty-seven participants had follow-up data. M ild hypertension is a significant risk factor for cardiovascular mortality and morbidity. 1 Treatment of mild hypertension significantly reduces this mortality and morbidity, 2 -5 but the cost/benefit ratio has been questioned. 6 How best to treat mild hypertension is undecided and remains a controversial point. 7 ' 8 The symptomatic and biochemical side effects, need for long-term use and cost of pharmacological treatment for all hypertensive

In the Hypertension Detection and Follow-up Program, 7825 (71.5 per cent) of the 10,940 participants had diastolic blood pressures averaging between 90 and 104 mm Hg on entry into the study and were designated Stratum 1. Half were referred to their usual source of care in the community (the referred-care group), and half were treated intensively in special clinics (the stepped-care group). Five-year mortality in the Stratum 1 patients given stepped care was 20.3 per cent lower than in those given referred care (P less than 0.01). Particularly noteworthy was the beneficial effect of stepped-care treatment on persons with diastolic pressures of 90 to 104 mm Hg who had no evidence of end-organ damage and were not receiving antihypertensive medication when they entered the study. This subgroup had 28.6 per cent fewer deaths at five years among those treated with stepped care than among those treated with referred care (P less than 0.01). These findings support a recommendation that in patients with mild hypertension, treatment should be considered early, before damage to end organs occurs.

This multicenter, double-blind, placebo-controlled study compares the effects of captopril treatment with those of digoxin treatment during maintenance diuretic therapy in patients with mild to moderate heart failure. Compared with placebo, captopril therapy resulted in significantly improved exercise time (mean increase, 82 s vs 35 s) and improved New York Heart Association class (41% vs 22%), but digoxin therapy did not. Digoxin treatment increased ejection fraction (4.4% increase) compared with captopril therapy (1.8% increase) and placebo (0.9% increase). The number of ventricular premature beats decreased 45% in the captopril group and increased 4% in the digoxin group in patients with more than ten ventricular premature beats per hour. Treatment failures, increased

Summary: Serum digoxin concentration was determined by radioimmuno‐assay in a group of 41 hospitalized adult patients (22 males and 19 females), selected prospectively for constant effective dosage with digoxin for at least three weeks, without clinical or electrocardiographic evidence of digoxin intoxication. Serum creatinine values were within the normal or near‐normal range. The majority were receiving diuretic therapy which was associated with mild alkalosis (75% of patients) and occasionally hypomagnesaemia (18%). The patients were considered to be effectively digitalized. The mean serum digoxin concentration six hours after the morning oral dose of digoxin in 28 of the 41 patients, with normal serum creatinine values, was 1.3 ng/ml (S.D. 0.4 ng/ml), and in the other 13 patients with mildly elevated serum creatinine values (range 1.3 to 1.6 mg/dl for 6 males and 1.1 to 1.4 mg/dl for 7 females) was 1.4 ng/ml (S.D. 0.7 ng/ml). Approximate GFR (% of normal corrected for age and surface area) was derived from auto‐analyzer serum creatinine values, using the formulae 110/serum creatinine concentration (mg/dl) for males and 85/serum creatinine for females. The patients with mild renal failure (approximate GFR, males 85 to 69% of normal; females, 77 to 61% of normal) were found to be significantly older and required significantly smaller oral maintenance doses of digoxin than the patients with normal serum creatinine valuestoachieve virtually the same serum digoxin concentration. Formulae were derived to enable calculation of the therapeutic daily dose of digoxin from age in years (A), weight in kg (W), sex and serum creatinine concentration in mg/dl (SCr) as follows:—