Wilder's principle: pre-treatment value determines post-treatment response

Abstract

Over more than half a century numerous studies have documented that pre-treatment blood pressure (BP) is a determinant of the anti-hypertensive response.^1–9 This has been shown for systolic and diastolic BP, acute and long-term response, monotherapy and combination therapy, and for office BP as well as for 24 h ambulatory BP. The first observation along that line was perhaps made by Freis et al. who, in 1958, in a very careful in-patient study reported a decrease in BP with chlorothiazide in every single hypertensive patient whereas in 15 normotensive subjects followed under exactly similar dietary and hospital control conditions, no reduction in BP occurred.¹⁰ This phenomenon that the pre-treatment level determines to a large extent the change per se, that is, the principle of initial value (German: Ausgangswertgesetz) was first described by Josef Wilder in 1931 who proposed that the ‘direction of response of body function to any agent depends to a large degree on the initial valuable of that function’.^11,12