Combination antihypertensive therapy: rational selection.

Traditionally, diuretics have been the only agents considered appropriate for initial antihypertensive treatment, and other drugs have been added sequentially. Diuretics may cause a number of adverse metabolic effects as well as a decrease in the quality of life for some patients. Currently, physicians are modifying their approach to treating hypertension and using alternatives to diuretics as initial therapy. Diuretics are often used in combination with many of the newer antihypertensive drugs. Some antihypertensive agents, such as the angiotensin-converting enzyme inhibitors, may blunt the adverse metabolic effects of the diuretics with which they are combined. This review discusses the advantages and disadvantages of beta-adrenergic blocking agents, calcium-channel blockers, and alpha-adrenergic blocking agents.