Treatment of hypertension in the 1990s. Optimizing the benefit of blood pressure reduction by minimizing risk factors for cardiovascular disease.

Due to the potency and multiple actions of available agents, current antihypertensive therapy can control blood pressure in virtually every patient with hypertension. In the past, physicians were primarily concerned with blood pressure reduction; the side effects of antihypertensive agents were a matter of lesser concern. Today, however, drugs can be selected for therapy on the basis of providing optimal antihypertensive efficacy and minimal harmful side effects. Furthermore, now that blood pressure can be effectively managed and the overall incidence of stroke has been reduced, perhaps the aim of therapy in patients with hypertension should include the reduction of coronary heart disease incidence. Three broad categories of antihypertensive agents are available: diuretics, antisympathetic agents, and vasodilators. Each class of drugs has its own pattern of action and produces optimal efficacy in identifiable patient populations, and each has a distinct side-effect profile. Knowledge of these variables and a scheme that can identify patients likely to benefit from a specific agent are paramount considerations in the treatment of hypertension.