PL 03-3 THE FUTURE DEVELOPMENT OF DRUG THERAPY FOR HYPERTENSION.

There is a whole armament of good drugs for treatment of hypertension including diuretics, calcium antagonist, angiotensin receptor antagonists and angiotensin converting enzyme inhibitors. Secondary drugs mostly used for special indications include beta-blockers, alpha-blockers, mineralocorticoid receptor antagonists (aldosterone antagonists), renin-inhibitors, centrally acting drugs, direct vasodilators and others.A variety of new drugs targeting different pressor mechanism exist and have partly been studies experimentally but will unlikely make it to clinical use in human hypertension. The reason for this is mainly the fact that all existing drugs are generic and inexpensive. The clinical development of new drugs has thus halted because industry does not get paid back for their investments. A recent example is the angiotensin receptor neprilysin inhibitor which has success in the treatment of heart failure at least partly because of powerful blood pressure lowering properties. However, one may also wonder whether potential harmful effects from long term treatment such as deposition of beta-amyloid in the brain may influence the risk of Alzheimer and prohibit development for use in hypertension.Against the solid documentation of today's first line drugs on preventing the cardiovascular complications of hypertension potential new drugs on the market would need to be tested in mega-trials before likely to be successful. Even if proven effective the cost issue would remain as a major barrier.Thus, the future development of drug therapy for hypertension would be improving the clinical aspects including overcoming clinical inertia and adherence to the drugs. In other words education of physicians and patients to make the right choices and follow-up on treatment that has been initiated. Targets are always the same - patients with well controlled blood pressure and without side effects. Adherence may be facilitated with drug monitoring in blood and urine, and combinations of complimentary drugs - usually given once daily and in the same pill. People with uncontrolled hypertension should be detected and treated to target blood pressure <140/90 mmHg, rather rapidly in high risk people, and then maintained with controlled BP <140/90 mmHg.