Arch Hellen Med, 17(5), September-October 2000, 450-462
Recent developments in the treatment of arterial hypertension
H. LYDAKIS,1 A.D. EFSTRATOPOULOS2
1“Venizelion” Hospital, Heraklion, Crete
2General Hospital of Athens “G. Gennimatas”, Athens, Greece
Since the publication in 1997 by the Joint National Committee VI and the WHO/International Society of Hypertension of the guidelines on high blood pressure treatment and control extensive research has extended our knowledge but at the same time new issues have emerged. The significant role of the mediterranean dietary pattern in the prevention of cardiovascular disease has been demonstrated in a recent study. In the last two years large studies were reported which showed the benefit of the newer classes of antihypertensive drugs, calcium channel blockers (CCB) and angiotensin converting enzyme inhibitors (ACEI) so far as hard end points (major morbidity and mortality) are concerned. Drug combinations are increasingly preferred because of maximum doses of monotherapy, the lower side effects and probably better therapeutic result. Treating hypertension in the elderly is especially rewarding. In this age group the CCBs have proved to be effective, which may not be the case with β-blockers. In diabetic hypertensive patients the administration of CCBs appears to be safe, although the ACEIs remain the first drug choice. The latter drugs are also consistently found to exert the best antiproteinuric effect in patients with mild–moderate renal failure and proteinuria. The great number of the ongoing studies are expected to give answers to new issues including further insight into the individualization of treatment, new targets for blood pressure values, new cardiovascular markers etc.
Key words: Angiotensin converting enzyme inhibitors, Calcium channel blockers, Drug treatment, Hypertension.