Antihypertensive Therapy: Newer Concepts and Agents

Major advances have taken place in recent years with respect to our understanding of hypertensive diseases, the mechanisms of action of other therapeutic agents, and the introduction of new classes of drugs. Standard therapy today uses the basic of employing nonpharmacological modalities. Thereafter a stepped-care program with pharmacological entities has been advocated using diuretic, antiadrenergic, and vasodilating agents. However, new modes of action have been introduced therapeutically during these years through inhibition of heretofore unexplored pressor mechanisms; some may be used monotherapeutically. Just precisely how the beta-adrenergic blocking drugs reduce arterial pressure still remains to be elucidated. We do not fully understand why the angiotensin-converting enzyme inhibitors work in patients with hypertension who do not have high (or even suppressed) plasma renin activity, but they are effective. Clinical studies directed toward these questions as well as toward other new classes of antihypertensive agents (including how the calcium ion affects vascular smooth muscle contractility) should provide continued enlightenment as to the pathogenesis and pathophysiology of essential hypertension. Moreover, knowledge of newer compounds that possess unique mechanisms of action should stimulate new thinking about this enigmatic disease of blood pressure regulation that we term 'essential hypertension' as well as more specific control of arterial pressure in this ubiquitous disease.