Hypertension and vascular disease in the 1990s

Many pharmacologic agents are effective in normalizing blood pressure in the hypertensive patient. The major issues in antihypertensive therapy today transcend control of blood pressure and focus, instead, on safety considerations, patient acceptance, and additional benefits to target organs. With the drugs currently available, 10-15% of patients withdraw from therapy because of undesirable clinical side effects. Nonclinical side effects such as hyperlipidemia, hypokalemia, and hyperglycemia can limit the clinician's choice of drugs, especially for elderly patients. Antihypertensive agents should also limit target organ damage. The prevalence of stroke can be reduced solely by controlling blood pressure, but inhibition of cardiac ischemic events requires use of specific classes of agents. Beta blockers reduce mortality and reinfarction postmyocardial infarction, whereas angiotensin-converting enzyme (ACE) inhibitors affect several factors leading to heart failure, including cardiac and vascular hypertrophy, remodeling and dilatation postmyocardial infarction, and arrhythmias. Specific actions on intrarenal and other vascular dynamics may make these drugs appropriate for use in patients with diabetes and perhaps hypertensive kidney disease and systemic arterial disease. The range of options available in antihypertensive therapy in the 1990s affords the physician the opportunity to meet additional goals of therapy, specific for each patient.