Changing concepts in the management of hypertension

Experience in a hypertension clinic attended by 591 patients over a 13-year period has shown marked changes in the pattern of use of hypotensive agents. Thiazides have been used throughout the period in almost all cases. Methyldopa was used for most patients for almost a decade. Since 1967 there has been a steady increase in the use of beta adrenergic blocking agents, and these are now used for over 60% of patients attending the clinic. Combination beta adrenergic blocking agents with peripheral vasilodators such as hydrallazine and prazosin have provided a very effective means of controlling the blood pressure in moderate and severe hypertension. Prazosin, a new peripheral vasodilator, has been used in the treatment of 295 patients. In most cases it has been used in combination with a thiazide diuretic and beta adrenergic blocking agent. Open studies have demonstrated that this is an effective hypot .ensive agent. Side effects are few and are counteracted by combination with a beta adrenergic blocking agent. Prazosin and hydrallazine are being compared in double-blind studies.