Treatment of Mild Hypertension Study - TOMHS


To compare five drug treatments with placebo for long-term treatment of mild hypertension.


The combination of dietary and behavioral changes with drug monotherapy will result in significant reduction in blood pressure.

Study Design

Study Design:

Patients Screened: Not reported
Patients Enrolled: 902
NYHA Class: Not Reported
Mean Follow Up: mean follow-up 4.4 years
Mean Patient Age: 45-69
Female: 38%
Mean Ejection Fraction: Not Evaluated

Patient Populations:

Diastolic blood pressure 90-99 mmHg, or if previously treated with antihypertensive drugs, 85-99 mmHg.


History or evidence of cardiovascular disease or LV hypertrophy (based on ECG).

Primary Endpoints:

change in diastolic and sytolic blood pressure

Secondary Endpoints:

left ventricular mass, plasma lipid levels, death and major cardiovascular events (nonfatal MI, stroke, CHF, surgery for aortic aneurysm, CABG surgery, coronary angioplasty, thrombolytic therpay, hospitalization for unstable angina)

Drug/Procedures Used:

Chlorthalidone 15 mg/day (diuretic), acebutolol 400 mg/day (β-blocker), doxazosin 1 mg/day (alpha-1 agonist), amlodipine 5 mg/day, enalapril 5 mg/day, or placebo (all a.m. dosing). All patients received nutritional-hygienic advice (low weight, low sodium, low alcohol, increased exercise).

Principal Findings:

Drug therapy reductions were sizable and similar in all treatment groups (DBP decreased by 11.5 to 13.1 mmHg [vs 8.6 mmHg for placebo] and SBP decreased by 14.2 to 17.7 mmHg [vs 9.1 mmHg for placebo]). Drug groups had a nonsignificant reduction in death and major cardiovascular events (5.1% vs. 7.3%; p = 0.21). The only significant difference vs placebo for reduction in LV mass was with chlorthalidone (p=0.03). Drug therapy also was associated with better quality of life and decreased resting ECG abnormalities.


The addition of any one of five different classes of drugs to dietary and behavioral modifications resulted in significant additional reduction in blood pressure with few side effects.


JAMA 1993;270:713–724. Circulation 1995;91:698-706. LV mass assessment.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Statins, Diet, Hypertension

Keywords: Enalapril, Chlorthalidone, Sodium, Diuretics, Doxazosin, Electrocardiography, Calcium Channel Blockers, Diet, Sodium-Restricted, Quality of Life, Amlodipine, Hypertension

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