Drug Treatment of Hypertension: Types of Grug Therapy

By Cardiologist on February 17th, 2010

Hypertension is an important contributor to cardiovascular disease, which accounts for about half of all deaths in Western societies. Its proper control is therefore of major importance.

While there is still controversy about the proper criteria to diagnose hypertension, it is generally agreed that a person with an average blood pressure of 160/90 mm Hg or higher (measured on three occasions over a 2-month period) is hypertensive. A patient’s hypertension can then be classified into operational (prognostic) categories by diastolic pressure: untreated readings in the range of 90 to 104 mm Hg indicate mild hypertension; readings of 105 to 114 mm Hg indicate moderate hypertension; readings of 115 mm Hg or greater indicate severe hypertension.

Patients with moderate to severe hypertension, those with hypertensive end organ damage, and those with co-existing risk factors for atherosclerosis (diabetes, hyperlipidemia, family history of early stroke or myocardial infarction) should be treated with antihypertensive drugs once the diagnosis is made, since such patients have clearly been shown to benefit from drug therapy.

Patients with uncomplicated mild diastolic hypertension can be given a 3-month trial of non-drug therapy (weight reduction, moderation of alcohol intake, salt restriction, etc). If the diastolic pressure remains above 95 mm Hg after that period, drug therapy is then recommended.

The benefits of antihypertensive drug therapy in patients over 75 years old are less clear; higher diastolic blood pressures may be more acceptable than antihypertensive drug therapy.

The desired target blood pressure depends to a large extent on the clinical characteristics of the individual patient. Those with co-existing risk factors for atherosclerosis and target organ changes are generally treated more aggressively; an attempt is made to lower the diastolic blood pressure to below 90 mm Hg. Higher endpoints may have to be accepted for patients who are intolerant of multiple antihypertensive medications and for those with limited life expectancies.

Types of drug therapy

A variety of antihypertensive drugs are currently available (Table 1). A brief discussion of the principal advantages and drawbacks of the most commonly used drugs follows.

Table 1 Classification of Antihypertensive Drugs

Diuretics: Thiazide-Type, Potassium-Sparing, Loop

β-Adrenergic Blockers

α-Adrenergic Blockers

Central Sympatholytics

Peripheral Adrenergic Neuron Antagonists

Direct Arteriolar Vasodilators

Angiotensin-Converting Enzyme Inhibitors

Calcium Entry Blockers

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