The past, present and future of hypertension management: a potential role for AT(1)-receptor antagonists.

The benefits of effective antihypertensive treatment were established at least 40 years ago, but despite the availability of more reliable and better-tolerated antihypertensive drugs, the control of blood pressure remains poor in most patients. Long-term antihypertensive efficacy requires treatment that combines reliable 24-hour reduction of blood pressure with good tolerability to facilitate patient compliance. Treatment should also protect against target-organ damage. As the majority of negative cardiovascular effects of angiotensin II are mediated through the angiotensin II type 1 (AT(1)) receptor, specific blockade of this receptor is a rational approach for achieving these ideals. Several AT(1)-receptor blockers have been developed that combine antihypertensive efficacy and placebo-like tolerability - the latter being unique in the history of antihypertensive therapy. In experimental animals these drugs prevent or reverse target organ damage in the heart, the vasculature and the kidney. Ongoing large-scale outcome studies are now underway to establish the benefits of AT(1)-receptor blockade beyond blood pressure control.