Antihypertensive therapy

Over the past decade we have witnessed a metamorphosis in the treatment of hypertension. First, nonpharmacological modalities are employed and are followed by a stepped-care program with pharmacological entities including diuretic, beta-adrenergic receptor blocking, antiadrenergic, angiotensin-inhibiting, and vasodilating agents. Precisely how beta-adrenergic blocking drugs reduce arterial pressure still remains to be elucidated, and we still do not understand precisely how the diuretics, direct-acting smooth muscle relaxants, or even the angiotensin-converting enzyme inhibitors work. Nevertheless, it is clear that clinical studies directed toward these questions as well as toward other new classes of antihypertensive agents (including how the calcium-entry blockers, serotonin inhibitors, and others affect vascular smooth muscle contractility) should provide continued enlightenment as to the pathogenesis and pathophysiology of essential hypertension.