More than 60 million Americans, 20% of the population, have hypertension that requires drug therapy. At age 65–75, however, more than 60% of individuals have hypertension. The incidence is higher in blacks. The prevalence of hypertension in industrialized countries in general is similar to that in the white population of the United States. Hypertension is the most common indication both for visits to physicians and for the use of prescription drugs in the United States.
Most important, we only have four groups of drugs (diuretics, beta-blockers, angiotensinconverting enzyme (ACE) inhibitors, or angiotensin 11 receptor blockers (ARBs) and calcium antagonists) to treat this most common condition that leads to devastating events, particularly death and disability. I have purposely left out centrally acting agents (methyldopa and clonidine) and alpha-blockers because their use is limited to a few selected individuals.
At the onset of my discussions, I must emphasize that ACE I/ARBs are excellent, well-tested, but mild antihypertensive agents, and that calcium antagonists are the most powerful of the four antihypertensive agents available for management of moderate and severe hypertension. We would be lost if these agents were not part of our antihypertensive armamentarium.
ACE inhibitors and the identically acting ARBs are a major advance but represent a single class of agent.
KeywordsIschemic Heart Disease Calcium Antagonist Antihypertensive Agent Systolic Hypertension Target Organ Damage
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