| Although numerous prospective randomized trials since the Veterans
Administration studies clearly have attested to the efficacy and safety
of antihypertensive therapy, there remain some controversial issues
with all classes of antihypertensive drugs. Thiazide diuretics increase
the risk for new-onset diabetes and their long-term safety has been
questioned. Alpha-blockers do not reduce morbidity and mortality in
uncomplicated hypertension but are well known to cause a variety of
poorly tolerated side effects. The safety of calcium antagonists has
been questioned for many years, although recent large prospective randomized
trials such as Antihypertensive and Lipid-Lowering Treatment to Prevent
Heart Attack Trial, International VERAPAMIL-TRANDOLAPRIL Study,
Intervention as a Goal in Hypertension, VALSARTAN Antihypertensive
Long-Term Use Evaluation and the Anglo-Scandinavian Cardiac Outcomes
Trial (ASCOT) have attested to their safety and efficacy. Angiotensin-converting
enzyme inhibitors, in general, are well tolerated but have potentially
fatal adverse effects in a few patients. Angiotensin-receptor blockers
are exceedingly well tolerated, but may be less-efficacious antihypertensive
agents than other drug classes. Most antihypertensive drug classes
have an effect on new-onset diabetes that should be taken into account
in patients at risk. No head-to-head comparison of combination therapy
looking at efficacy and safety has been available. The long-term safety
of antihypertensive therapy is documented poorly because most trials
only last 4 to 6 years. Despite these drawbacks and concerns, the benefits
of antihypertensive therapy clearly outweigh its potential risk. |
