Prevention of target organ damage with modern antihypertensive agents

This review summarises the recent epidemiological data on hypertension, the aims of the treatment of hypertension, and emphasizes the importance of the modification of target organ damages and accelerated clinical conditions. Because the pathogenesis of hypertension is extremely complex, the therapy most likely requires a combined drug administration. The modern third generation dihydropyridine calcium channel blocker, amlodipine, not only has a favourable antihypertensive and anti-ischemic effect, but anti-atherosclerosis properties as well. There are plenty of evidence which demonstrate that lisinopril, a first line antihypertensive agent, has a positive effect in the treatment of left ventricular hypertrophy, retinopathy and nephropathy, and also has a favourable outcome after myocardial infarction and in heart failure. The combined administration of the two drugs leads to a favourable additive effect, with a decrease in the number and severity of side effects. The results of the ASCOT study proved a favourable effect with amlodipine based, combination therapy with an ACE-inhibitor, compared with the traditional beta-blockers and diuretics. The data of the CAFE sub-study showed, that in spite of the similar peripheral antihypertensive effect, the amlodipine based therapy decreased the central aortic pulse pressure to a greater extent. The central aortic pressure showed a good correlation with the end-points of the study, respectively. The results of the Hungarian multicenter study (HAMLET) proved the effective and safe administration of the two drugs in combination. Based on the above evidence, the fixed-dose combination of the CCB-ACE inhibitor (amlodipine-lisinopril) has not only effective blood pressure reducing properties, but also results in cardiovascular risk reduction, good tolerability and favourable compliance.