Drug therapy for hypertension: where we are, and where we might be heading.

The past two decades have witnessed major improvements in antihypertensive drug therapy. Although diuretics and beta-adrenergic antagonists remain the drugs of choice, we now recommend much lower doses than we previously did. This appears to achieve equal blood pressure control while causing fewer side effects. Angiotensin-converting enzyme inhibitors and calcium antagonists are newer, relatively expensive drug classes whose benefits can be exploited in certain subgroups of patients. Whether they will lead to improved outcome in the uncomplicated hypertensive patient remains uncertain. New classes of drugs affecting the renin-angiotensin system are in various stages of development. Again, they have theoretical advantages over those currently available. Still other classes--thromboxane synthase or receptor antagonists and endothelin antagonists--appear promising in animal studies. Finally, in future, it may be possible to cure hypertension by altering a patient's genetic make-up.