Author Affiliation: Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Mass.
The "graying" of the population has increased the number of patients
with hypertension, threatening these patients' quality and length of life.
The challenge for physicians treating patients with hypertension is to normalize
blood pressure effectively, with as few therapeutic misadventures and medication-related
symptoms as possible, at the least possible cost.
Early in the development of antihypertensive agents, it was generally
assumed that comparative trials of specific antihypertensive agents were unnecessary
because treatments that lowered blood pressure equally were likely to yield
equal clinical benefit. This belief led to the use of blood pressure as a
surrogate marker and sufficient basis for approval for labeling drugs for
use as antihypertensive agents.1 However, as
new drugs were developed with very different mechanisms of action and adverse
event profiles, this theory began to be reevaluated. In fact, it seems likely
that certain groups of patients—such as those with diabetes, left ventricular
dysfunction, angina pectoris, migraine, prostatism, or lipid disorders—may
reap different advantages from different antihypertensive drug groups.2 This belief, in part, led to the suggestion in the
"Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure" that initial antihypertensive drug choices
take into account the comorbid conditions of the patients being treated.3
Lasagna L. Diuretics vs α-Blockers for Treatment of HypertensionLessons From ALLHAT. JAMA. 2000;283(15):2013-2014. doi:10.1001/jama.283.15.2013