It has been clearly demonstrated that treatment of hypertension prevents strokes, heart attacks and deaths from cardiovascular disease. This has been shown by studying thousands of patients with hypertension and enrolling them in clinical trials in which the effects of anti hypertensive treatment has been compared to either placebo (inactive medication), or a less rigorous treatment approach. The studies that demonstrated the beneficial effects of blood pressure lowering medication were conducted over the last 25 years, and the drugs utilized were diuretics and beta blockers. Many physicians treat hypertension in the year 2000 with more recently developed drugs such as angiotensin converting enzyme inhibitors, angiotensin receptor antagonists and calcium channel blockers. These drugs compare favorably with diuretics and beta blockers with respect to their ability to lower blood pressure.
However, so far, less information is available regarding the ability of these drugs to prevent strokes, heart attacks and deaths from cardiovascular disease. This situation will change in the near future, because a very large clinical trial now in progress called the ALLHAT trial will be completed in the next few years. In this trial, the newer drugs will be compared with the older drugs to determine if they have the same long term benefits in patients with hypertension. Until the results of this study is available, it is good practice to treat hypertension with diuretics and beta blockers. However, since most patients need more than one medication to lower their blood pressure to normal, the newer agents are often very effective, and well tolerated. Furthermore, in patients with kidney disease, particularly diabetic kidney disease, angiotensin converting enzyme inhibitors are effective in slowing the progression of kidney disease.