Why not prescribe the best drugs for hypertension now?

• Published in: Journal of human hypertension Vol. 17; no. 7; pp. 505 - 511
• Main Authors: WONG, S. Y. S, MCINNES, G. T, MACDONALD, T. M
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing 01-07-2003; Nature Publishing Group
• Subjects: Angiotensin II; Angiotensin Receptor Antagonists; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive agents; Antihypertensive drugs; Antihypertensives; Biological and medical sciences; Blood pressure; Cardiovascular system; Chronic illnesses; Clinical trials; Dosage and administration; Drug development; Drug therapy; Evaluation; Humans; Hypertension; Hypertension - drug therapy; Medical sciences; Patient Acceptance of Health Care; Patient compliance; Peptidyl-dipeptidase A; Pharmacology. Drug treatments; Renin; Risk groups; Human; Hypertension; Prognosis; Enzyme; Indication; angiotensin II receptor antagonists; Enzyme inhibitor; Cardiovascular disease; Peptidases; Chemotherapy; Renin angiotensin system; Treatment; Peptidyl-dipeptidase A; Hydrolases; Peptidyl-dipeptidases; Antihypertensive agent; Angiotensin antagonist; ACE inhibitors; renin-angiotensin system
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/sj.jhh.1001576

As Westernised societies have become more affluent, the attitudes of the population have become more risk-aware. People are now intolerant of small risks as well as the physical or mental discomforts from drug side effects. Safety and tolerability are now major forces driving the development of new medicines for the treatment of chronic illnesses and the prevention of increasingly rare events. For example, over the past decades, lower and lower treatment thresholds have been recommended in hypertension. Public perception of risk strongly influences the acceptability of lifetime treatment, especially for mild hypertension. This era has also witnessed great advances in the development of antihypertensive drugs that combine efficacy with unsurpassed tolerability. However, the philosophy of Scottish teachers of Materia medica still appears to be followed-'never be the first or the last to prescribe a new drug'. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists are as safe and as efficacious as other antihypertensive medications and better tolerated. Large trials (HOT, HOPE, UKPDS and PROGRESS) point to the need for rigorous control of blood pressure particularly in high-risk individuals. Antihypertensive drugs that act on the renin-angiotensin system will probably impact significantly on achieving optimal blood pressure levels. Should it not now be accepted that high-risk patients should have ACE inhibitors and angiotensin II receptor antagonists prescribed as first-line agents? We review the evidence for the use of ACE inhibitors and angiotensin II receptor antagonists as antihypertensive agents.