Angiotensin converting enzyme inhibition and calcium channel blockade as primary antihypertensive therapy.

Recent large-scale antihypertensive treatment trials primarily emphasize the quality of blood pressure control for reduction of cerebrovascular accidents as well as for myocardial infarction, practically irrespective of the type of drug used. Therefore, the best drug that normalizes blood pressure without adverse effects should be sought. On the basis of studies demonstrating cellular membrane and calcium homoeostatic derangements, and an age-dependent transition of overall cardiovascular regulation and peripheral vasoconstrictor forces during the course of essential hypertension, an alternative treatment concept is proposed: angiotensin converting enzyme inhibitors or beta-blockers can primarily be used in younger patients and those with a high renin, while calcium antagonists are used in place of diuretics in older, low-renin or black patients. Age-oriented two-way drug selection enables normalization of blood pressure without untoward effects in about 80% of patients with essential hypertension, and helps to optimize drug combinations in those patients who are difficult to treat.