Hypertension update for the 1980s

The treatment of hypertension must be based on pathophysiologic grounds. The drugs that have been used in the classic stepped-care approach are still useful, but the rationale for their usage should not be based on the presumption that all hypertension is mediated by salt and water. Thus, the adolescent obtains greater benefits from a beta-adrenergic blocking drug or a centrally acting antihypertensive. The individual with heart failure may benefit more from a converting enzyme inhibitor than a vasodilator. In cerebrovascular disease with hypertension, dosage must be reduced owing to the enhanced sensitivity of response. New drugs are discussed, and their place in the armamentarium is evaluated.