Achieving blood pressure targets in the management of hypertension.

The 1999 World Health Organization-International Society of Hypertension guidelines state that the goal of antihypertensive therapy should be to restore blood pressure to a level defined as normal (<130/85 mmHg). Yet, despite significant efforts in diagnosing and treating hypertension, blood pressure is normalized in less than one-third of hypertensive patients worldwide. Inadequate blood pressure control is most likely to occur when treatment is ineffective, intolerable or both. Hypertension is a heterogeneous disease involving several pressor systems. It is therefore not surprising that a single drug normalizes blood pressure in only a fraction of hypertensive patients. Co-administering two medications that lower blood pressure by different mechanisms generally increases antihypertensive efficacy. The angiotensin II receptor antagonist (AIIRA) class represents a new therapeutic option: a class of agents that provide blood pressure reduction similar to other classes of antihypertensives with the additional advantage of an excellent tolerability profile. The AIIRA irbesartan has demonstrated dose-related efficacy in reducing blood pressure as monotherapy and augmented efficacy in combination with low doses of the diuretic hydrochlorothiazide. Efforts should be directed to normalize blood pressure in every hypertensive patient by finding a drug regimen that is simultaneously effective and well tolerated.