[Antihypertensive drugs in 2010: old and new agents]

High blood pressure is a major cardiovascular risk factor and its treatment reduces the risk. Five classes of antihypertensive drugs are suitable for the treatment of hypertension either as monotherapy or in some combinations with each other: thiazide and thiazide-like diuretics, beta-blockers, calcium antagonists, angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists. The benefits of antihypertensive treatment are mainly due to lowering of blood pressure and are largely independent of the drug employed. For a given reduction in blood pressure, there is no evidence that "new" antihypertensive agents are superior to "old" agents. In the majority of patients, two or more antihypertensive drugs are required to achieve target blood pressure levels. Preferred drug combinations are diuretics with any of other antihypertensive drugs (with the exception of the combination with beta-blockers in patients at risk of diabetes mellitus), and angiotensin-converting enzyme inhibitors with calcium antagonists. On the other hand, the combination of an angiotensin-converting enzyme inhibitor with an angiotensin receptor antagonist should not be employed because of a high incidence of serious adverse renal outcomes. Recently, the first orally active direct renin inhibitor, aliskiren, has been launched for clinical use. The results of ongoing long-term outcome studies will determine the place of aliskiren in the treatment of hypertension.