Shortcomings of current antihypertensive therapy

Effective antihypertensive agents have been available for the last four decades. Their use in the treatment of hypertension has resulted in a marked decline in hypertension-induced morbidity and mortality. There are, however, some notable shortcomings with the currently available antihypertensive therapies, including disappointing effects against coronary artery disease and the fact that, even with treatment, hypertensive patients still have considerably higher cardiovascular morbidity and mortality than matched normotensives. This may be due to insufficient lowering of the elevated arterial pressure in hypertensive patients. In theory, overtreatment may also constitute a risk, considering the J-curve phenomenon. Other factors which may play a role are the different pathophysiological mechanisms in stroke and myocardial infarction, the potentially negative metabolic effects induced by some antihypertensive drugs, the importance of cardiovascular hypertrophy (in particular, left ventricular hypertrophy), and the inability of some antihypertensive agents to reverse such changes. To rectify some of these shortcomings, a more effective antihypertensive therapy is required. Ideally, an antihypertensive agent should provide effective lowering of blood pressure, in most patients to normotensive levels, while being devoid of potentially negative metabolic effects. It should also induce reversal of the changes of cardiovascular hypertrophy and, if possible, limit tissue damage if and when a vascular complication occurs.