The clinical relevance of pharmacological blood pressure lowering mechanisms.

Hypertension is a major risk factor for stroke, myocardial infarction, heart failure and kidney failure. Clinical trials demonstrate that lowering blood pressure can substantially reduce cardiovascular risk, and current clinical practice guidelines identify lowering blood pressure as a priority in the treatment of people with hypertension and set clear treatment targets. In addition to lifestyle modifications, which should be pursued in all patients, a large number of antihypertensive drugs and combinations of such drugs are part of the modern treatment armamentarium. Following the publication of the Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial (ALLHAT), some investigators and clinicians have suggested that thiazide diuretics should be the first drug of choice for the treatment of all hypertensive patients. However, antihypertensive drugs differ greatly in their mechanisms of action, pharmacokinetic properties and side effects. There are also large variations among hypertensive patients with regards to the pathophysiology of their blood pressure elevation, response to individual antihypertensive drugs, comorbidities and propensity to drug-related side effects. Therefore, a uniform formula for the treatment of hypertension is not likely to achieve optimal results. Rather, treatment strategies based on careful, comprehensive and individualized patient assessments should be pursued.