A. Number of Drugs Available
Hypertension affects more than 1 billion individuals worldwide and is the most common indication for both visits to physicians and for the use of prescription drugs in the United States, yet there are only five groups of drugs available to treat this condition. After more than 50 years of research and proclamations on television and in popular magazines of new drugs, the hope of patients dissipates when the new agents are tried without success. This situation is appalling when worldwide more than 1 billion individuals require treatment.
Only five antihypertensive drugs are available.
1. Diuretics
2. Beta-adrenergic blockers
3. ACE inhibitors and angiotensin II receptor blockers
4. Calcium antagonists (calcium channel blockers)
5. Alpha blockers (use limited because of increased risk for heart failure)
ACE inhibitors and the identical acting angiotensin II receptor blockers are a major advance but represent a single class of agent. Although this class of agent is represented by more than 24 drug names in the market¬place, they have the same actions and represent a single drug
Calcium antagonists are not superior to the two older classes of agents, beta-blockers and diuretics. Alpha-blockers are not recommended agents and the recent ALLHAT trial indicates that they increase the incidence of heart failure. These agents are therefore used only in selected individuals, particularly with renal dysfunction, when an ACE inhibitor may be contraindicated and blood pressure remains uncontrolled with other agents. The older centrally acting agents clonidine and methyldopa caused depression and other adverse effects and have been rendered obsolete, although methyldopa still holds a place in the management of hypertension in pregnancy.

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