Achieving blood pressure targets in the management of hypertension

The 1999 World Health Organization-International Society of Hypertension gu idelines state that the goal of antihypertensive therapy should be to resto re blood pressure to a level defined as normal (< 130/85 mmHg). Yet, despit e significant efforts in diagnosing and treating hypertension, blood pressu re is normalized in less than one-third of hypertensive patients worldwide. Inadequate blood pressure control is most likely to occur when treatment i s ineffective, intolerable or both. Hypertension is a heterogeneous disease involving several presser systems. It is therefore not surprising that a s ingle drug normalizes brood pressure in only a fraction of hypertensive pat ients. Go-administering two medications that lower blood pressure by differ ent mechanisms generally increases antihypertensive efficacy. The angiotens in II receptor antagonist (AIIRA) class represents a new therapeutic option : a class of agents that provide blood pressure reduction similar to other classes of antihypertensives with the additional advantage of an excellent tolerability profile. The AIIRA irbesartan has demonstrated dose-related ef ficacy in reducing blood pressure as monotherapy and augmented efficacy in combination with low doses of the diuretic hydrochlorothiazide. Efforts sho uld be directed to normalize blood pressure in every hypertensive patient b y finding a drug regimen that is simultaneously effective and well tolerate d.