According to current guidelines for the diagnosis and treatment of hypertension, five main classes of anti-hypertensive drugs are currently recommended for the treatment of hypertension: diuretics, beta-blockers, calcium antagonists, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists. These classes of drugs are conventionally considered basic, since they have a solid evidence base not only in order to reduce blood pressure, but also to reduce the risk of cardiovascular complications.
Based on the results of international multicenter, randomized studies, we can see that none of these classes of antihypertensive drugs have a significant advantage in terms of reducing blood pressure and preventing the development of MTR. At the same time, the choice of the drug in hypertension is determined by many factors associated with this disease: lesion of target organs , associated clinical conditions, renal pathology, diabetes mellitus, and other diseases. In the new version of the recommendations, when choosing a drug, great importance is attached to pleiotropic (multiple) effects, which will be discussed below. In general, each of the main classes of drugs has its own niche of use.
As for the I1 agonists of the imidazoline receptor and α-adrenoblockers, they are recommended mainly as part of a combination therapy.
Regardless of the choice of drug, it is necessary to achieve the main objective of antihypertensive therapy – to achieve the target level of blood pressure, which is the basis for ensuring the strategic goal of treatment of hypertension – the maximum possible reduction in the risk of SSO.
In the new recommendations for the diagnosis and treatment of arterial hypertension, target blood pressure levels in the treatment of patients with hypertension should be a blood pressure of less than 140/90 mm Hg. In patients with high and very high risk of SSO, it is necessary to reduce blood pressure to 140/90 mm Hg. and less for 4 weeks. In the future, under the condition of good tolerability, a decrease in blood pressure to 130–139 / 80–89 mm is recommended.
In this work, I would like to dwell on the new possibilities of various classes of drugs, as well as the problematic issues of their use, taking into account the pleiotropic effects outlined in modern guidelines.