Desirable therapeutic characteristics of an optimal antihypertensive agent

Abstract

Hypertension affects 65 million people in the US, and is a major cause of morbidity and mortality, but less than one-third of patients with hypertension are treated to goal blood pressure. Multiple factors have been cited, and include suboptimal adherence to treatment and lifestyle modifications, limited access to healthcare services, and the failure of health professionals to treat hypertension aggressively. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends a goal blood pressure of <140/90mm Hg for most patients and <130/80mm Hg for those with diabetes mellitus or chronic kidney disease. The 'ideal' antihypertensive agent would have a number of characteristics: (i) effective in lowering blood pressure to recommended goals; (ii) high efficacy as monotherapy; (iii) rapid onset of effect; (iv) convenient once-daily dose administration to maximise compliance; (v) sustained efficacy over 24 hours; (vi) response increases with higher doses (clear dose-response effect); and (vii) optimum tolerability profile. Although the ideal agent does not yet exist and will vary from patient to patient, drug development and new formulations have provided more options for clinicians and patients and certain drug classes appear to show promise because they possess many beneficial characteristics. Hypertension treatment needs to be tailored to individual patients' age, race, socioeconomic situation, concomitant conditions and family history. Physicians and other clinical providers have an important role to play in hypertension management, particularly by combining culturally sensitive patient care with aggressive treatment. Regular follow-up that is directed at achieving goal blood pressure, while monitoring the patient for possible drug-related adverse effects, will help ensure and support adherence to treatment regimens. By supporting the integration of lifestyle changes into this plan, the clinician can further influence and have a positive impact on a patient's overall cardiovascular profile.