Choosing Initial Antihypertensive Drug Therapy for the Uncomplicated Hypertensive Patient

Choosing the initial antihypertensive drug for the uncomplicated hypertensive patient is an important and frequent event for the primary care physician. Patients' first experience with antihypertensive drug therapy will likely affect their long-term perception of hypertension treatment. The choice should be made on the basis of sound scientific data and from the patient's perspective and needs. The drug should be taken once a day, should have proven efficacy in hypertension control and cardiovascular morbidity and mortality reduction, and should have as few side effects as possible. Low-dose thiazide diuretics meet this description, although the need to monitor electrolytes may make them less than ideal. The angiotensin II receptor antagonist class, with side-effects similar to those of placebo in controlled trials, is the most attractive from the patient's perspective, although outcome trial data do not yet exist proving that hypertension treatment with angiotensin II receptor antagonists reduces cardiovascular events. The angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, with their low side-effect profiles and unique effects on vascular remodeling, are attractive second choices to combine with a diuretic if needed, although low-dose diuretic/β blocker combinations have also been shown to lower blood pressure with minimal side effects. At present, ensuring adequate long-term hypertension control is the most important aspect of hypertensive care, and which antihypertensive drug(s) the physician chooses can greatly affect the hypertensive patient's ability to achieve and to maintain long-term blood pressure control.