Adequate control of blood pressure

Adequate control of blood pressure poses challenges for hypertensive patients and their
physicians. Success rates of greater than 80% in reducing blood pressure to target values
among high-risk hypertensive patients reported by several recent clinical trials argue that
effective medications currently are available. Yet, only 34% of hypertensive patients in the
United States are at their goal blood pressure according to the most recent national survey.
Rational selection of antihypertensive drugs that target both the patient’s blood pressure
and comorbid conditions coupled with more frequent use of low-dose drug combinations
that have additive efficacy and low adverse-effect profiles could improve significantly US
blood pressure control rates and have a positive impact on hypertension-related cardiovascular and renal mortality and morbidity. This article reviews the pharmacokinetic and
pharmacodynamic principles that underlie the actions of drugs in each of the classes of
antihypertensive agents when used alone and in combination, provides practical pharmacologic information about the drugs most frequently prescribed for treatment of hypertension in the outpatient setting, and summarizes the current data influencing the selection of
drugs that might be used most effectively in combination for the majority of hypertensive
patients whose blood pressures are not controlled adequately by single-drug therapy.
Semin Nephrol 25:215-226 © 2005 Elsevier Inc. All rights reserved.