Therapeutic implications of recent megatrials in hypertension: in favor of new drugs.

Blood pressure reduction represents a key priority for any preventive strategy in hypertension. However, one of the issues that has been raised repeatedly over the last few years is whether blood pressure reduction is all that matters in the treatment of hypertension, or if other properties related to antihypertensive drugs may be relevant for cardiovascular and renal outcomes. In this view, a long debate has emerged in the scientific and medical community, whether the newer classes of antihypertensive agents have additional properties beyond blood pressure control and, further, are superior to traditional antihypertensive drugs. The evidence accumulated over the last 20 years have consistently demonstrated that "new" drugs are as effective as "old" drugs in terms of blood pressure-lowering effect and in several clinical trials even more effective than old drugs on major cardiovascular outcomes. In addition, they have been demonstrated to effectively antagonize the progression of the hypertensive disease, as monitored through the development of intermediate end points. Finally, in view of the need for using combination therapy to effectively achieve blood pressure control in the clinical management of hypertension, the antihypertensive combinations based on new drugs, especially those using angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers with a low-dose thiazide diuretic or those using calcium channel blockers and ACE inhibitors, are now considered more effective and safer than those using beta-blockers and low-dose thiazide diuretic, especially in view of their better metabolic profile and their better tolerability.