Abstract
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.
Keywords: hypertension, beta-adrenergic blockers, angiotensin-converting enzyme inhibitors, alpha-adrenergic blockers, calcium channel blockers
Full text
PDF






Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Amery A., Fagard R., Fiocchi R., Lijnen P., Staessen J., Vermylen J. Antihypertensive action and serotonin-induced platelet aggregation during long-term ketanserin treatment in hypertensive patients. J Cardiovasc Pharmacol. 1984 Jan-Feb;6(1):182–185. [PubMed] [Google Scholar]
- Atkinson A. B., Robertson J. I. Captopril in the treatment of clinical hypertension and cardiac failure. Lancet. 1979 Oct 20;2(8147):836–839. doi: 10.1016/s0140-6736(79)92186-x. [DOI] [PubMed] [Google Scholar]
- Buckingham R. E., Clapham J. C., Hamilton T. C., Longman S. D., Norton J., Poyser R. H. BRL 34915, a novel antihypertensive agent: comparison of effects on blood pressure and other haemodynamic parameters with those of nifedipine in animal models. J Cardiovasc Pharmacol. 1986 Jul-Aug;8(4):798–804. doi: 10.1097/00005344-198709010-00022. [DOI] [PubMed] [Google Scholar]
- Bühler F. R., Bolli P., Kiowski W., Erne P., Hulthén U. L., Block L. H. Renin profiling to select antihypertensive baseline drugs. Renin inhibitors for high-renin and calcium entry blockers for low-renin patients. Am J Med. 1984 Aug 20;77(2A):36–42. [PubMed] [Google Scholar]
- Carruthers S. G. Severe coughing during captopril and enalapril therapy. CMAJ. 1986 Aug 1;135(3):217–218. [PMC free article] [PubMed] [Google Scholar]
- Croog S. H., Levine S., Testa M. A., Brown B., Bulpitt C. J., Jenkins C. D., Klerman G. L., Williams G. H. The effects of antihypertensive therapy on the quality of life. N Engl J Med. 1986 Jun 26;314(26):1657–1664. doi: 10.1056/NEJM198606263142602. [DOI] [PubMed] [Google Scholar]
- Curtis J. J., Luke R. G., Dustan H. P., Kashgarian M., Whelchel J. D., Jones P., Diethelm A. G. Remission of essential hypertension after renal transplantation. N Engl J Med. 1983 Oct 27;309(17):1009–1015. doi: 10.1056/NEJM198310273091702. [DOI] [PubMed] [Google Scholar]
- Dannenberg A. L., Drizd T., Horan M. J., Haynes S. G., Leaverton P. E. Progress in the battle against hypertension. Changes in blood pressure levels in the United States from 1960 to 1980. Hypertension. 1987 Aug;10(2):226–233. doi: 10.1161/01.hyp.10.2.226. [DOI] [PubMed] [Google Scholar]
- Frishman W. H., Furberg C. D., Friedewald W. T. Beta-adrenergic blockade for survivors of acute myocardial infarction. N Engl J Med. 1984 Mar 29;310(13):830–837. doi: 10.1056/NEJM198403293101306. [DOI] [PubMed] [Google Scholar]
- Goldberg L. I. Dopamine receptors and hypertension. Physiologic and pharmacologic implications. Am J Med. 1984 Oct 5;77(4A):37–44. doi: 10.1016/s0002-9343(84)80036-4. [DOI] [PubMed] [Google Scholar]
- Gould B. A., Hornung R. S., Kieso H. A., Cashman P. M., Raftery E. B. Prazosin alone and combined with a beta-adrenoreceptor blocker in treatment of hypertension. J Cardiovasc Pharmacol. 1983 Jul-Aug;5(4):678–684. doi: 10.1097/00005344-198307000-00024. [DOI] [PubMed] [Google Scholar]
- Helgeland A. Treatment of mild hypertension: a five year controlled drug trial. The Oslo study. Am J Med. 1980 Nov;69(5):725–732. doi: 10.1016/0002-9343(80)90438-6. [DOI] [PubMed] [Google Scholar]
- Hricik D. E., Browning P. J., Kopelman R., Goorno W. E., Madias N. E., Dzau V. J. Captopril-induced functional renal insufficiency in patients with bilateral renal-artery stenoses or renal-artery stenosis in a solitary kidney. N Engl J Med. 1983 Feb 17;308(7):373–376. doi: 10.1056/NEJM198302173080706. [DOI] [PubMed] [Google Scholar]
- Hyman D., Kaplan N. M. Treatment of patients with mild hypertension. Hypertension. 1985 Mar-Apr;7(2):165–170. doi: 10.1161/01.hyp.7.2.165. [DOI] [PubMed] [Google Scholar]
- Kubik M. M., Coote J. H. Propranolol vs metoprolol vs labetalol: a comparative study in essential hypertension. Eur J Clin Pharmacol. 1984;26(1):1–6. doi: 10.1007/BF00546699. [DOI] [PubMed] [Google Scholar]
- Larochelle P., Genest J., Kuchel O., Boucher R., Gutkowska Y., McKinstry D. Effect of captopril (SQ 14225) on blood pressure, plasma renin activity and angiotensin I converting enzyme activity. Can Med Assoc J. 1979 Aug 4;121(3):309–316. [PMC free article] [PubMed] [Google Scholar]
- Leren P. Comparison of effects on lipid metabolism of antihypertensive drugs with alpha- and beta-adrenergic antagonist properties. Am J Med. 1987 Jan 5;82(1A):31–35. doi: 10.1016/0002-9343(87)90141-0. [DOI] [PubMed] [Google Scholar]
- Lijnen P., Fagard R., Groeseneken D., M'Buyamba J. R., Staessen J., Amery A. The hypotensive effect of captopril in hypertensive patients is age-related. Methods Find Exp Clin Pharmacol. 1983 Nov;5(9):655–660. [PubMed] [Google Scholar]
- Loutzenhiser R., Epstein M. Effects of calcium antagonists on renal hemodynamics. Am J Physiol. 1985 Nov;249(5 Pt 2):F619–F629. doi: 10.1152/ajprenal.1985.249.5.F619. [DOI] [PubMed] [Google Scholar]
- Man in 't Veld A. J., Schicht I. M., Derkx F. H., de Bruyn J. H., Schalekamp M. A. Effects of an angiotensin-converting enzyme inhibitor (captopril) on blood pressure in anephric subjects. Br Med J. 1980 Feb 2;280(6210):288–290. doi: 10.1136/bmj.280.6210.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McDonald J. W., Ali M., Morgan E., Townsend E. R., Cooper J. D. Thromboxane synthesis by sources other than platelets in association with complement-induced pulmonary leukostasis and pulmonary hypertension in sheep. Circ Res. 1983 Jan;52(1):1–6. doi: 10.1161/01.res.52.1.1. [DOI] [PubMed] [Google Scholar]
- McKibbin J. K., Pocock W. A., Barlow J. B., Millar R. N., Obel I. W. Sotalol, hypokalaemia, syncope, and torsade de pointes. Br Heart J. 1984 Feb;51(2):157–162. doi: 10.1136/hrt.51.2.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moncloa F., Sromovsky J. A., Walker J. F., Davies R. O. Enalapril in hypertension and congestive heart failure. Overall review of efficacy and safety. Drugs. 1985;30 (Suppl 1):82–89. doi: 10.2165/00003495-198500301-00012. [DOI] [PubMed] [Google Scholar]
- Moser M. Treating hypertension. A review of clinical trials. Am J Med. 1986 Dec 31;81(6C):25–32. doi: 10.1016/0002-9343(86)90525-5. [DOI] [PubMed] [Google Scholar]
- Sowers J. R., Whitfield L. A., Catania R. A., Stern N., Tuck M. L., Dornfeld L., Maxwell M. Role of the sympathetic nervous system in blood pressure maintenance in obesity. J Clin Endocrinol Metab. 1982 Jun;54(6):1181–1186. doi: 10.1210/jcem-54-6-1181. [DOI] [PubMed] [Google Scholar]
- Stamler R., Stamler J., Gosch F. C., Berkson D. M., Dyer A., Hershinow P. Initial antihypertensive drug therapy: alpha blocker or diuretic. Interim report of a randomized, controlled trial. Am J Med. 1986 Feb 14;80(2A):90–93. doi: 10.1016/0002-9343(86)90165-8. [DOI] [PubMed] [Google Scholar]
- Weinberger M. H. Antihypertensive therapy and lipids. Paradoxical influences on cardiovascular disease risk. Am J Med. 1986 Feb 14;80(2A):64–70. doi: 10.1016/0002-9343(86)90162-2. [DOI] [PubMed] [Google Scholar]
- Wilson T. W., Firor W. B., Johnson G. E., Holmes G. I., Tsianco M. C., Huber P. B., Davies R. O. Timolol and propranolol: bioavailability, plasma concentrations, and beta blockade. Clin Pharmacol Ther. 1982 Dec;32(6):676–685. doi: 10.1038/clpt.1982.223. [DOI] [PubMed] [Google Scholar]
