Modern approaches to initiating antihypertensive therapy

From the five broad classes of antihypertensive drugs that have been in use long enough for adequate clinical experience to be obtained, the most recent report of the Joint National Committee on Hypertension recommends drugs from two older classes--the diuretics and the beta-adrenergic blockers--as first-line treatment. This article argues that newer drugs and in particular the angiotensin-converting enzyme inhibitors may be equally or more appropriate as first choice. Physicians should choose on the basis of a drug's pharmacologic properties and the patient's clinical profile, rather than according to a generic set of rules. Considering that the goals of modern antihypertensive therapy are not only lowering of blood pressure to prevent complications, but also long-term cardioprotection without adverse effects on the quality of life, some newer drugs might even prove more cost-effective in the long run.