Alpha-adrenergic blockers, calcium antagonists and some angiotensin-converting enzyme (ACE) inhibitors are now promoted as first-line drugs for the treatment of hypertension, competing with the traditional choices of β-adrenergic blockers and diuretics. The older drugs have established long-term benefits, but have some theoretical disadvantages and sometimes unwanted effects. No trials have looked at the impact of these new drugs on cardiovascular disease; studies of their efficacy have examined only immediate outcome measures such as blood pressure, and their effects on other risk factors for arterial disease such as plasma lipids. Choosing a drug for the initial treatment of hypertension has therefore become more difficult. We discuss here a new α-blocker and three recently marketed calcium antagonists.
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