The evolution of antihypertensive therapy: an overview of four decades of experience

Department of Internal Medicine, Ochsner Clinic, New Orleans, Louisiana 70121.

Hypertension is a major public health problem amendable to treatment. Numerous large scale clinical trials have demonstrated that effective, sustained control of elevated arterial pressure to a level below 140/90 mm Hg results in reduced cardiovascular morbidity and mortality. Over the past 4 decades antihypertensive drug therapy has evolved from a stepwise, but physiologically rational, selection of agents to specific programs tailored to individualized therapy for specific clinical situations. This evolution has taken place because of a greater understanding of the pathophysiology of hypertensive diseases, the development of new classes of antihypertensive agents that attack specific pressor mechanisms, and the ability to wed these concepts into a rational and specific therapeutic program. Thus, with the currently available spectrum of antihypertensive therapy, we are now able to select treatment for special patient populations utilizing a single agent and, therefore, we can protect the heart, brain and kidneys and maintain organ function without exacerbating associated diseases. These benefits are clear-cut and have resulted in many millions of patients becoming the beneficiaries of this transfer of careful, painstaking and purposeful investigative experiences into clinical practice.