New perspectives in the treatment of hypertension with arterial disease.

The results of large-scale clinical trials of the therapy of mild hypertension have cast some doubts upon the routine use of current approaches in those at relatively low risk. Therefore, we must consider both the relative degree of risk for the individual patient and the potential risks of the therapy to be used. Those patients with preexisting arterial disease are, by nature, at a higher degree of risk. Their arterial disease likely reflects the interactions of multiple risk factors, all of which must be considered. Therefore, they will more likely need active drug therapy as well as multiple changes in diet, physical activity, and other life habits. The degree and nature of preexisting arterial disease may also influence the choice of drug therapy. In particular, further aggravation of hypercholesterolemia and glucose intolerance must be avoided and more careful attention must be given to avoid hypokalemia. The use of beta-adrenergic blocking drugs may be particularly well-suited to those with coronary disease although here, too, attention must be given to their potential for elevation of serum triglycerides and decrease in renal blood flow. Newer types of therapy, including calcium-entry blockers, converting enzyme inhibitors, and serotonin antagonists will probably be of particular use in such patients.