Do pharmacologic differences among antihypertensive agents point to clinical benefits?

On the basis of results of long-term trials, to date, it is reasonable to conclude that blood pressure lowering, per se, rather than the identity of the antihypertensive regimen, is associated with reducing risk for stroke and coronary heart disease in patients with hypertension. Clinicians should identify drugs within each antihypertensive class that reduce blood pressure consistently over a 24-hour period and have a duration appropriate for once-daily administration. Candesartan cilexetil is an appropriate choice among angiotensin II receptor blockers (ARBs); it has a trough: peak ratio of 0.9-1.1, which fully justifies once-daily dosing. Once genuinely long-acting antihypertensive medications are used routinely, it will be possible to evaluate whether the different drug classes provide ancillary benefits beyond blood pressure lowering.