Choosing initial therapy for hypertension. A personal view.

With numerous safe and effective antihypertensive drugs now available, the clinician should no longer choose only diuretic agents or beta-adrenergic receptor blockers (beta-blockers) as initial therapy. Five classes of agents, including angiotensin converting enzyme inhibitors, beta-blockers, calcium entry blockers, peripheral alpha 1-adrenergic receptor blockers, and thiazide diuretic agents, are all appropriate monotherapy in properly selected patients. The choice depends on efficacy, side effects, demography, comorbidity, dosage schedule, cost, mechanism of drug action, and the pathophysiology of the patient's hypertension. Extensive data are now available that will assist the clinician in choosing an agent that has the greatest probability of success without the need for extensive biochemical or hemodynamic evaluation.