Careful selection of antihypertensive agents based on pharmacologic action and side effects can optimize blood pressure control and patient compliance.
May support diuretic-first step-care for hypertension; leaves open validation in contemporary populations with current agents.
A wide variety of drugs are available for treatment of hypertension. Diuretics, long the sole therapy, can control blood pressure in more than 40% of patients. If a diuretic alone proves inadequate, a beta-adrenergic blocking agent, vasodilator, and central-acting sympathetic inhibitor may be added, as needed, in the familiar four-step program. A calcium channel blocker, with its vasodilating effects, or an angiotensin-converting enzyme inhibitor may be considered in appropriate situations. Selection among these agents should be based on knowledge of their pharmacologic action, duration of action, and side effects. With careful selection, blood pressure can be better controlled, side effects minimized, and patient compliance improved.
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Orme et al. (1984) studied this question.
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