New drugs for the treatment of hypertension: where do they fit?

In the past decade several new antihypertensives have been marketed. Some, like the new beta blockers, are related to pre-1977 drugs, while others, the angiotensin-converting enzyme inhibitors, alpha blockers, and calcium channel blockers, are entirely new classes. While the newer agents have definite advantages, the extent of these benefits must be weighed against their cost. Drug costs for a two-drug regimen of captopril and diltiazem are 25 times those of hydrochlorothiazide and propranolol. The new beta blockers seem to have modest overall advantages: angiotensin-converting enzyme inhibitors are useful for patients who cannot accept a diminution in exercise tolerance; calcium channel blockers are useful for elderly hypertensives who have a contraindication for thiazides. Hypertension is being increasingly better controlled, with a concomitant reduction in cardiovascular mortality. The challenge for the next decade will be to achieve reductions in atherosclerotic, as well as hypertensive, complications without interfering with the users' quality of life. In this paper the authors review the new drugs and indicate what groups of patients might be benefited by them.