Targeting antihypertensive therapy to the individual patient

Currently, there are of a plethora not only of blood pressure-lowering medications but classes thereof. This massive armamentarium is a luxury, but has also raised appropriate concern that the long-term use of many of the agents may result in adverse effects that may offset their benefits. Because of this, the physician's choice of an initial antihypertensive agent has become even more important. Indeed, the initially chosen medication will often be taken for the longest time. The purpose of this review is to consider the major factors permitting a rational choice of medication, including demographic considerations such as race and age, coexisting diseases that commend one agent rather than another, safety, patient acceptance (quality of life), potential interactions with other drugs, and additional salutary effects. The question of the role of nondiuretic monotherapy is, of necessity, an integral component of this discussion. Preliminary data indicate that the use of this approach with some of the newer agents, including calcium channel blockers and converting enzyme inhibitors and blockers, constitutes excellent therapy in many patients. Finally, because of the new approaches to antihypertensive therapy in comprehensive risk management, the effect of medication on the metabolic and lipid profile are also considered.