State-of-the-art treatment of hypertension: established and new drugs.
The treatment of essential hypertension is based essentially on the prescription of four major classes of antihypertensive drugs, i.e. blockers of the renin--angiotensin system, calcium channel blockers, diuretics and beta-blockers. In recent years, very few new drug therapies of hypertension have become available. Therefore, it is crucial for physicians to optimize their antihypertensive therapies with the drugs available on the market. In each of the classes of antihypertensive drugs, questions have recently been raised: are angiotensin-converting enzyme (ACE) inhibitors superior to angiotensin II receptor blockers (ARB)? Is it possible to reduce the incidence of peripheral oedema with calcium antagonists? Is hydrochlorothiazide really the good diuretic to use in combination therapies? The purpose of this review is to discuss these various questions in the light of the most recent clinical studies and meta-analyses. These latter suggest that ACE inhibitors and ARB are equivalent except for a better tolerability profile of ARB. Third generation calcium channel blockers enable to reduce the incidence of peripheral oedema and chlorthalidone is certainly more effective than hydrochlorothiazide in preventing cardiovascular events in hypertension. At last, studies suggest that drug adherence and long-term persistence under therapy is one of the major issues in the actual management of essential hypertension.
Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 17, Lausanne 1011, Switzerland.
Michel
M
Burnier
Yann
Y
Vuignier
Gregoire
G
Wuerzner
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004095:Dihydropyridines / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D015195:Drug Design; D004359:Drug Therapy, Combination; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D017410:Practice Guidelines as Topic
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D004232:Diuretics
Angiotensin receptor blockers; Calcium antagonists; Diuretics; Drug adherence