New insights into the treatment of hypertension

1. The choice of initial pharmacological therapy is one area where the different hypertension management guidelines vary in recommending either the use of diuretics and beta-blockers as preferred drugs or choosing from any of the five major classes of antihypertensives. 2. Improvement in cardiovascular morbidity and mortality may have been shown most conclusively with diuretics and beta-blockers, but the effects on coronary events with these drugs were less than predicted and the other agents have a number of theoretical advantages. 3. Recent worries regarding the possible adverse effects of calcium antagonists have led to a reappraisal of the risks and benefits of these drugs and antihypertensives in general. 4. Many patients, particularly the elderly, have other conditions that influence the choice of first-line therapy and ethnic variations in the effects of hypertension or the efficacy or side effects of drugs should also be taken into account. 5. There is considerable heterogeneity within the major categories of antihypertensive drugs, so it is important to distinguish the different subgroups, dosages and formulations that may be used.