Clinical overview of antihypertensive classes - Clinically relevant differences: Myths or facts?

The goals of antihypertensive therapy are to lower blood pressure and preve nt end-organ damage without side effects, which affect quality of life. The antihypertensive drugs, regardless of class, all lower blood pressure, but they vary in their mechanisms of action, side-effect profiles, suitability for patients with Other comorbid conditions, and ability to protect agains t the long-term sequelae of hypertension. The Sixth Report of the joint Nat ional Committee on. Prevention, Evaluation, and Treatment of High Blood Pre ssure (JNC-VI) recommends diuretics and beta-blockers as first-line therapy for uncomplicated hypertension, with diuretics also being strongly preferr ed for patients with isolated systolic hypertension or hypertension and hea rt failure and beta-blockers being strongly preferred for patients who have had a myocardial infarction (MI) and those with hypertension and angina, a trial tachycardia, or atrial fibrillation. Because angiotensin-converting e nzyme (ACE) inhibitors have been shown to be cardioprotective and renoprote ctive in patients with diabetes or impaired left ventricular (LV) function, the JNC-VI recommends them as first-link therapy in patients with diabetes with proteinuria, heart failure, and MI complicated by LV dysfunction. It recommends calcium channel blockers for hypertensive patients with angina, long-acting dihydropyridines for those with isolated systolic hypertension, and the nondihydropyridines for those with atrial tachycardia or fibrillat ion, diabetes, and proteinuria. The angiotensin II receptor blockers (ARBs) share many of the organ-protective effects of ACE inhibitors when studied in animal models. They are effective in lowering blood pressure and have a very benign side-effect profile; however, these agents have not been availa ble long enough to ascertain their efficacy in protecting against long-term complications.