There are many more choices these days for hypertension treatment than when I started out.

Once several agents became available, we used to choose medications according to what type of patient we had in front of us.

A person with leg oedema and hypertension would be put on a diuretic, a type A personality with a high resting pulse would get a beta blocker, a patient with heart disease might get an ACE inhibitor, and a person who might not show up for their bloodwork or follow-up appointment would get a modern calcium channel blocker such as amlodipine.

Then came the statistics that showed slightly better outcomes for diuretics and ACE inhibitors, and all of a sudden we were supposed to take those small differences seriously enough to force all patients into the same treatment algorithm.