New developments in the treatment of hypertension: are some antihypertensives more equal than others?

In 2002, a major topic of discussion in the field of clinical hypertension was the efficacy of the various types of antihypertensive agents. The results of three large endpoint studies have recently been published and it was hoped that these would provide some answers. What could be concluded from their findings is that angiotensin II receptor (A II) antagonists can now also be allowed as initial treatment for uncomplicated essential hypertension. Thiazide diuretics remain the treatment of choice in patients with uncomplicated essential hypertension because of low costs. Recent trials suggest however, that agents that interfere in the renin-angiotensin system, such as ACE inhibitors and A II antagonists, may be superior in preventing end-organ damage. We therefore propose that subgroups of patients should be defined, in which specific agents should be preferentially used because of proven efficacy.