New developments in the management of hypertension.

The management of hypertension has evolved over the past decade. Isolated systolic blood pressure elevation, the most common form of uncontrolled hypertension, is recognized as a significant risk factor for vascular complications in patients with hypertension. Nutritional management of hypertension has moved beyond simply restricting sodium intake to ensuring that patients consume adequate amounts of the major food groups, particularly those containing calcium, potassium, and magnesium. Selective aldosterone receptor blockers are a new class of antihypertensive medication, and the angiotensin-receptor blocker class has several new additions. However, the main-stay of treatment remains a diuretic or a combination of a diuretic and either a beta blocker or an angiotensin-converting enzyme inhibitor. Hypertension is a significant risk factor for vascular complications of diabetes, and the target blood pressure in patients with diabetes or chronic renal disease and hypertension should be lower than that in patients with hypertension alone. Controlling hypertension in elderly patients can reduce their complications at least as much as it does those of younger patients with hypertension.