title: [Achievements and problems of modern trials of antihypertensive drugs].
abstract: Most important value of lowering of substantially elevated arterial pressure (AP) for improvement of outcomes in patients with arterial hypertension (AH) was convincingly confirmed by large truly placebo controlled randomized clinical trials (RCT) with the use of mainly diuretics, and/or beta-adrenoblockers in the 60-80ths. Later comparative RCT confirmed equal antihypertensive efficacy of 5 main drug classes relative to AP level in brachial artery. In this review we discuss merit of auxiliary class-specific properties of antihypertensive agents potentially affecting prognosis besides AP lowering. We also discuss problems related to decline of significance of quantitative criteria of AH and consideration of AP level in general context of cardiovascular risk; problems of external validity of RCT; extrapolation of RCT results obtained in patients with complicated AH and very high cardiovascular risk on young patients with uncomplicated AH; significance of hard and surrogate end points.
authors.forename: Zh D
authors.initials: ZhD
authors.lastname: Kobalava
authors.forename: Iu V
authors.initials: IuV
authors.lastname: Kotovskaia
mesh_terms: D000959:Antihypertensive Agents / Q000145:classification / Q000266:history / Q000494:pharmacology / Q000592:standards; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D057186:Comparative Effectiveness Research / Q000379:methods / Q000592:standards / Q000639:trends; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D004346:Drug Information Services / Q000458:organization & administration; D015987:Effect Modifier, Epidemiologic; D049673:History, 20th Century; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards / Q000639:trends; D018570:Risk Assessment
chemical_list: D000959:Antihypertensive Agents