Antihypertensive Drugs_ A Journal Review

Antihypertensive Drugs: A Journal Review

Antihypertensive drugs remain a cornerstone in the management of hypertension, a major risk factor for cardiovascular disease. Recent journal publications have highlighted significant advancements in our understanding of these medications, their mechanisms of action, and their role in various patient populations. This review summarizes key findings from recent studies published in high-impact journals focusing on antihypertensive drugs.

One of the most notable trends in recent literature is the emphasis on personalized medicine in hypertension management. The PATHWAY-2 study, published in The Lancet, demonstrated the superiority of spironolactone as a fourth-line agent in resistant hypertension. This finding has led to a reevaluation of treatment algorithms for patients with difficult-to-control blood pressure.

The debate over first-line therapy choices continues to evolve. A meta-analysis in the Journal of the American Medical Association (JAMA) compared the efficacy of different antihypertensive drug classes in reducing cardiovascular events. The study found that while all major classes (ACE inhibitors, ARBs, calcium channel blockers, and thiazide diuretics) were effective in reducing cardiovascular events, there were subtle differences in their effects on specific outcomes.

The role of combination therapy has been a focus of several recent publications. The ACCOMPLISH trial, revisited in the New England Journal of Medicine, reinforced the benefits of combining an ACE inhibitor with a calcium channel blocker over the combination of an ACE inhibitor with a thiazide diuretic. This has implications for initial combination therapy strategies, particularly in high-risk patients.

Novel drug classes have also garnered attention. The DENER-HTN trial, published in The Lancet, explored the use of renal denervation as an adjunct to standardized stepped-care antihypertensive treatment. While the results were promising, they also highlighted the need for careful patient selection and standardized procedures.

The importance of chronotherapy in hypertension management has been emphasized in recent literature. A study in the European Heart Journal demonstrated that bedtime dosing of antihypertensive medications, as opposed to morning dosing, resulted in better blood pressure control and reduced cardiovascular events.

Safety profiles of antihypertensive drugs continue to be scrutinized. A large-scale observational study published in the British Medical Journal (BMJ) examined the association between antihypertensive drugs and cancer risk. The study found no evidence of increased cancer risk with long-term use of antihypertensive medications, providing reassurance to both clinicians and patients.

The management of hypertension in special populations has been a focus of recent research. A systematic review in Hypertension explored the optimal management of hypertension in pregnancy, highlighting the safety and efficacy of certain antihypertensive drugs in this vulnerable population.

The role of genetics in response to antihypertensive therapy has gained traction. A pharmacogenomic study published in Nature Genetics identified genetic variants associated with differential responses to thiazide diuretics, paving the way for more targeted therapy selection.

Emerging technologies in drug delivery systems for antihypertensive medications have been reported. A study in the Journal of Controlled Release described a novel long-acting, injectable formulation of amlodipine, which could potentially improve medication adherence in hypertensive patients.

The impact of antihypertensive drugs on cognitive function has been a subject of recent investigations. A longitudinal study in JAMA Neurology suggested that certain classes of antihypertensive drugs may have protective effects against cognitive decline and dementia. 

Antihypertensive Drugs_ A Historical Overview

Antihypertensive Drugs: A Historical Overview

The history of antihypertensive drugs is a fascinating journey that spans over a century, marked by groundbreaking discoveries and continuous improvements in treating hypertension. This narrative showcases the evolution of medical understanding and pharmaceutical innovation in managing one of the most prevalent chronic conditions worldwide.

Early 20th Century: The Dawn of Hypertension Treatment

1900s-1940s: Limited understanding of hypertension led to primitive treatments like bloodletting and strict salt restriction.

1940s: Introduction of thiocyanate and quaternary ammonium compounds as the first chemical treatments for hypertension. However, these had severe side effects and limited efficacy.

1950s-1960s: The First Major Breakthroughs

1950: Discovery of hexamethonium, the first ganglionic blocker, marked the beginning of effective pharmacological treatment of hypertension.

1957: Introduction of chlorothiazide, the first thiazide diuretic, revolutionized hypertension treatment due to its effectiveness and relatively mild side effects.

1960s: Development of beta-blockers, with propranolol being the first clinically used beta-blocker for hypertension in 1964.

1970s-1980s: Expanding the Arsenal

1970s: Introduction of calcium channel blockers, with verapamil being one of the first.

1975: Discovery of captopril, the first angiotensin-converting enzyme (ACE) inhibitor, opened a new era in hypertension treatment.

1980s: Refinement of ACE inhibitors led to the development of enalapril and lisinopril, with improved safety profiles.

1990s-2000s: New Classes and Refined Treatments

1995: Approval of losartan, the first angiotensin receptor blocker (ARB), provided an alternative for patients intolerant to ACE inhibitors.

Late 1990s-early 2000s: Development of long-acting formulations of existing drugs improved patient compliance and efficacy.

2007: Introduction of aliskiren, the first direct renin inhibitor, added a new class to the antihypertensive arsenal.

Key Milestones and Contributions:

1940s: Dr. Irvine Page's description of the renin-angiotensin system laid the groundwork for future ACE inhibitors and ARBs.

1950s: Dr. James Black's work on beta-blockers (for which he later won a Nobel Prize) transformed both hypertension and heart disease treatment.

1970s: Dr. John Vane's research on prostaglandins and ACE inhibitors (also a Nobel Prize winner) led to the development of captopril.

1980s-1990s: Large-scale clinical trials like ALLHAT and HOPE provided crucial data on the efficacy and long-term outcomes of various antihypertensive drugs.

Evolving Treatment Paradigms:

1960s-1970s: Step-care approach, starting with diuretics and adding other drugs as needed.

1980s-1990s: Individualized approach based on patient characteristics and comorbidities.

2000s-present: Evidence-based guidelines emphasizing combination therapy and early intervention.

Recent Developments and Future Directions:

Combination pills: Single pills containing multiple antihypertensive agents to improve adherence.

Precision medicine: Tailoring treatments based on genetic profiles and biomarkers.

Novel targets: Research into new pathways and mechanisms for blood pressure control.

Non-pharmacological approaches: Increased focus on lifestyle modifications and interventional procedures like renal denervation.

The history of antihypertensive drugs reflects a remarkable journey of scientific discovery and clinical innovation. 

Antihypertensive Drugs_ A Comprehensive Table

Antihypertensive Drugs: A Comprehensive Table

Here's a comprehensive table of antihypertensive drugs, categorized by class, including generic names, common brand names, and their primary mechanisms of action:

<table>

<thead>

<tr>

<th>Drug Class</th>

<th>Generic Name</th>

<th>Common Brand Names</th>

<th>Primary Mechanism of Action</th>

</tr>

</thead>

<tbody>

<tr>

<td>ACE Inhibitors</td>

<td>Lisinopril</td>

<td>Prinivil, Zestril</td>

<td>Inhibits ACE, reducing angiotensin II production</td>

</tr>

<tr>

<td></td>

<td>Enalapril</td>

<td>Vasotec</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Ramipril</td>

<td>Altace</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Benazepril</td>

<td>Lotensin</td>

<td></td>

</tr>

<tr>

<td>ARBs</td>

<td>Losartan</td>

<td>Cozaar</td>

<td>Blocks angiotensin II receptors</td>

</tr>

<tr>

<td></td>

<td>Valsartan</td>

<td>Diovan</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Irbesartan</td>

<td>Avapro</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Olmesartan</td>

<td>Benicar</td>

<td></td>

</tr>

<tr>

<td>Calcium Channel Blockers</td>

<td>Amlodipine</td>

<td>Norvasc</td>

<td>Blocks calcium influx into vascular smooth muscle and cardiac cells</td>

</tr>

<tr>

<td></td>

<td>Nifedipine</td>

<td>Procardia, Adalat</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Diltiazem</td>

<td>Cardizem, Tiazac</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Verapamil</td>

<td>Calan, Isoptin</td>

<td></td>

</tr>

<tr>

<td>Beta-Blockers</td>

<td>Metoprolol</td>

<td>Lopressor, Toprol-XL</td>

<td>Blocks beta-adrenergic receptors</td>

</tr>

<tr>

<td></td>

<td>Atenolol</td>

<td>Tenormin</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Propranolol</td>

<td>Inderal</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Carvedilol</td>

<td>Coreg</td>

<td></td>

</tr>

<tr>

<td>Thiazide Diuretics</td>

<td>Hydrochlorothiazide</td>

<td>Microzide</td>

<td>Increases sodium and water excretion</td>

</tr>

<tr>

<td></td>

<td>Chlorthalidone</td>

<td>Thalitone</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Indapamide</td>

<td>Lozol</td>

<td></td>

</tr>

<tr>

<td>Loop Diuretics</td>

<td>Furosemide</td>

<td>Lasix</td>

<td>Inhibits sodium and chloride reabsorption in the loop of Henle</td>

</tr>

<tr>

<td></td>

<td>Bumetanide</td>

<td>Bumex</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Torsemide</td>

<td>Demadex</td>

<td></td>

</tr>

<tr>

<td>Potassium-Sparing Diuretics</td>

<td>Spironolactone</td>

<td>Aldactone</td>

<td>Blocks aldosterone receptors</td>

</tr>

<tr>

<td></td>

<td>Eplerenone</td>

<td>Inspra</td>

<td></td>

</tr>

<tr>

<td>Alpha-Blockers</td>

<td>Doxazosin</td>

<td>Cardura</td>

<td>Blocks alpha-1 adrenergic receptors</td>

</tr>

<tr>

<td></td>

<td>Prazosin</td>

<td>Minipress</td>

<td></td>

</tr>

<tr>

<td></td>

<td>Terazosin</td>

<td>Hytrin</td>

<td></td>

</tr>

<tr>

<td>Direct Vasodilators</td>

<td>Hydralazine</td>

<td>Apresoline</td>

<td>Directly relaxes vascular smooth muscle</td>

</tr>

<tr>

<td></td>

<td>Minoxidil</td>

<td>Loniten</td>

<td></td>

</tr>

<tr>

<td>Centrally Acting Agents</td>

<td>Clonidine</td>

<td>Catapres</td>

<td>Stimulates central alpha-2 adrenergic receptors</td>

</tr>

<tr>

<td></td>

<td>Methyldopa</td>

<td>Aldomet</td>

<td></td>

</tr>

<tr>

<td>Renin Inhibitors</td>

<td>Aliskiren</td>

<td>Tekturna</td>

<td>Directly inhibits renin</td>

</tr>

</tbody>

</table>

This table provides a quick reference for the main classes of antihypertensive drugs, their generic names, common brand names, and primary mechanisms of action. It's important to note that:

Brand names may vary by country or region.

Some medications may have multiple mechanisms of action.

Combination drugs (containing two or more antihypertensive agents) are not included in this table.

The choice of medication depends on various factors, including the patient's age, comorbidities, and potential side effects.

Always consult current clinical guidelines and prescribing information for the most up-to-date recommendations on antihypertensive therapy. 

Antihypertensive Drugs_ A Comprehensive Review

Antihypertensive Drugs: A Comprehensive Review

Hypertension remains a significant global health concern, contributing to cardiovascular morbidity and mortality. Antihypertensive drugs play a crucial role in managing this condition. This review article provides an overview of the major classes of antihypertensive medications, their mechanisms of action, indications, and recent developments in the field.

Angiotensin-Converting Enzyme (ACE) Inhibitors

Mechanism: Inhibit the conversion of angiotensin I to angiotensin II

Examples: Lisinopril, Ramipril, Enalapril

Indications: Hypertension, heart failure, post-MI, diabetic nephropathy

Side effects: Dry cough, angioedema, hyperkalemia

Angiotensin Receptor Blockers (ARBs)

Mechanism: Block the action of angiotensin II at AT1 receptors

Examples: Losartan, Valsartan, Telmisartan

Indications: Similar to ACE inhibitors, often used as alternatives when ACE inhibitors are not tolerated

Side effects: Generally well-tolerated, potential for hyperkalemia

Calcium Channel Blockers (CCBs)

Mechanism: Block calcium influx into vascular smooth muscle and cardiac cells

Examples: Amlodipine, Nifedipine, Diltiazem, Verapamil

Indications: Hypertension, angina, certain arrhythmias

Side effects: Peripheral edema, constipation (verapamil), gingival hyperplasia

Beta-Blockers

Mechanism: Block beta-adrenergic receptors, reducing heart rate and cardiac output

Examples: Metoprolol, Atenolol, Carvedilol

Indications: Hypertension, post-MI, heart failure, angina

Side effects: Fatigue, bradycardia, bronchospasm (in susceptible individuals)

Thiazide Diuretics

Mechanism: Inhibit sodium-chloride cotransporter in distal convoluted tubule, promoting sodium and water excretion

Examples: Hydrochlorothiazide, Chlorthalidone, Indapamide

Indications: Hypertension, often used as first-line therapy or in combination

Side effects: Electrolyte imbalances, hyperuricemia, glucose intolerance

Loop Diuretics

Mechanism: Inhibit sodium-potassium-chloride cotransporter in the loop of Henle

Examples: Furosemide, Bumetanide, Torsemide

Indications: Hypertension with renal impairment, heart failure

Side effects: Electrolyte imbalances, ototoxicity at high doses

Potassium-Sparing Diuretics

Mechanism: Block sodium channels in collecting duct (amiloride, triamterene) or antagonize aldosterone (spironolactone, eplerenone)

Examples: Spironolactone, Eplerenone, Amiloride

Indications: Hypertension, heart failure, primary aldosteronism

Side effects: Hyperkalemia, gynecomastia (spironolactone)

Alpha-1 Blockers

Mechanism: Block alpha-1 adrenergic receptors, causing vasodilation

Examples: Prazosin, Doxazosin, Terazosin

Indications: Hypertension, benign prostatic hyperplasia

Side effects: Orthostatic hypotension, first-dose syncope

Central-Acting Agents

Mechanism: Stimulate central alpha-2 receptors or imidazoline receptors, reducing sympathetic outflow

Examples: Clonidine, Methyldopa, Moxonidine

Indications: Hypertension, particularly in pregnancy (methyldopa)

Side effects: Dry mouth, sedation, rebound hypertension upon discontinuation

Recent Developments and Emerging Therapies:

Combination Therapies: Fixed-dose combinations of multiple antihypertensive agents have gained popularity, improving adherence and efficacy.

ARNI (Angiotensin Receptor-Neprilysin Inhibitor): Sacubitril/valsartan, initially approved for heart failure, shows promise in resistant hypertension.

Endothelin Receptor Antagonists: Drugs like macitentan are being studied for resistant hypertension, particularly in patients with chronic kidney disease. 

Antihypertensive Drugs_ A Comprehensive Overview

Antihypertensive Drugs: A Comprehensive Overview

Antihypertensive drugs are a crucial component in the management of hypertension, a major risk factor for cardiovascular diseases. Understanding these medications is essential for healthcare professionals to provide optimal patient care. Let's explore the main classes of antihypertensive drugs, their mechanisms of action, and key considerations.

Angiotensin-Converting Enzyme (ACE) Inhibitors:

Examples: Lisinopril, Enalapril, Ramipril

Mechanism: Inhibit ACE, reducing angiotensin II production

Effects: Vasodilation, decreased aldosterone secretion

Key considerations: Can cause dry cough, angioedema; avoid in pregnancy

<ol start=”2”>

Angiotensin Receptor Blockers (ARBs):

Examples: Losartan, Valsartan, Olmesartan

Mechanism: Block angiotensin II receptors

Effects: Similar to ACE inhibitors but without cough side effect

Key considerations: Generally well-tolerated; avoid in pregnancy

<ol start=”3”>

Calcium Channel Blockers (CCBs):

Examples: Amlodipine, Nifedipine, Diltiazem

Mechanism: Block calcium influx into vascular smooth muscle and cardiac cells

Effects: Vasodilation, decreased heart rate (non-dihydropyridines)

Key considerations: Can cause peripheral edema, constipation

<ol start=”4”>

Thiazide Diuretics:

Examples: Hydrochlorothiazide, Chlorthalidone

Mechanism: Inhibit sodium-chloride cotransporter in distal convoluted tubule

Effects: Increased sodium and water excretion, vasodilation

Key considerations: Can cause electrolyte imbalances, hyperuricemia

<ol start=”5”>

Beta-Blockers:

Examples: Metoprolol, Atenolol, Carvedilol

Mechanism: Block beta-adrenergic receptors

Effects: Decrease heart rate, cardiac output, and renin release

Key considerations: Can mask hypoglycemia symptoms, contraindicated in some respiratory conditions

<ol start=”6”>

Alpha-Blockers:

Examples: Prazosin, Doxazosin

Mechanism: Block alpha-1 adrenergic receptors

Effects: Peripheral vasodilation

Key considerations: Can cause orthostatic hypotension, first-dose syncope

<ol start=”7”>

Direct Vasodilators:

Examples: Hydralazine, Minoxidil

Mechanism: Directly relax vascular smooth muscle

Effects: Arterial vasodilation

Key considerations: Can cause reflex tachycardia, fluid retention

<ol start=”8”>

Aldosterone Antagonists:

Examples: Spironolactone, Eplerenone

Mechanism: Block aldosterone receptors

Effects: Promote sodium and water excretion, potassium retention

Key considerations: Can cause hyperkalemia, especially in renal impairment

<ol start=”9”>

Centrally Acting Agents:

Examples: Clonidine, Methyldopa

Mechanism: Stimulate central alpha-2 receptors or inhibit central sympathetic outflow

Effects: Decrease sympathetic nervous system activity

Key considerations: Can cause sedation, rebound hypertension if stopped abruptly

Key Principles in Antihypertensive Therapy:

Individualization: Choose drugs based on patient characteristics, comorbidities, and potential side effects.

Combination therapy: Many patients require multiple drugs to achieve target blood pressure.

Start low, go slow: Begin with low doses and titrate gradually to minimize side effects.

Monitor: Regular follow-ups to assess efficacy, side effects, and adherence.

Consider underlying causes: Address secondary causes of hypertension when present.

Lifestyle modifications: Encourage diet, exercise, and stress management alongside medication. 

Antihypertensive Drugs_ A Comprehensive Overview with Examples

Antihypertensive Drugs: A Comprehensive Overview with Examples

Antihypertensive drugs are a diverse group of medications designed to lower high blood pressure, a condition that affects millions worldwide and is a major risk factor for cardiovascular diseases. These drugs work through various mechanisms to reduce blood pressure and minimize the risk of complications associated with hypertension. Here's an overview of the main classes of antihypertensive drugs, along with specific examples of each:

Angiotensin-Converting Enzyme (ACE) Inhibitors:

ACE inhibitors prevent the formation of angiotensin II, a hormone that causes blood vessel constriction. By blocking this process, they allow blood vessels to relax and widen, reducing blood pressure.

Examples: Lisinopril, Enalapril, Ramipril, Captopril

Angiotensin Receptor Blockers (ARBs):

ARBs work similarly to ACE inhibitors but block the action of angiotensin II at its receptor sites.

Examples: Losartan, Valsartan, Irbesartan, Candesartan

Calcium Channel Blockers (CCBs):

These medications prevent calcium from entering heart and blood vessel cells, causing relaxation of blood vessels and reducing heart workload.

Examples: Amlodipine, Nifedipine, Diltiazem, Verapamil

Diuretics:

Often called ”water pills,” diuretics help the body eliminate excess sodium and water, reducing blood volume and pressure.

Examples: Hydrochlorothiazide, Chlorthalidone, Furosemide, Spironolactone

Beta-Blockers:

These drugs reduce heart rate and cardiac output, leading to lower blood pressure.

Examples: Metoprolol, Atenolol, Propranolol, Carvedilol

Alpha-Blockers:

By blocking alpha receptors in blood vessel walls, these medications prevent blood vessel constriction.

Examples: Doxazosin, Prazosin, Terazosin

Direct Vasodilators:

These drugs work directly on blood vessel muscles, causing them to relax and dilate.

Examples: Hydralazine, Minoxidil

Renin Inhibitors:

These medications block the enzyme renin, which is involved in the production of angiotensin I.

Example: Aliskiren

Central-Acting Agents:

These drugs work on the central nervous system to reduce sympathetic nervous system activity.

Examples: Clonidine, Methyldopa

Combination Drugs:

Many antihypertensive medications are available as combination pills, combining two or more classes of drugs in a single tablet.

Examples: Lisinopril/Hydrochlorothiazide, Amlodipine/Valsartan

The choice of antihypertensive medication depends on various factors, including the patient's age, race, comorbidities, and the presence of any compelling indications or contraindications. Many patients require a combination of two or more medications from different classes to achieve optimal blood pressure control.

It's important to note that while these medications are effective in lowering blood pressure, they are often most successful when combined with lifestyle modifications. These may include dietary changes (such as reducing sodium intake and following the DASH diet), regular physical activity, weight management, limiting alcohol consumption, and smoking cessation.

Side effects can occur with antihypertensive medications and vary depending on the specific drug and individual patient factors. Common side effects may include dizziness, fatigue, headache, and electrolyte imbalances. Some medications may also interact with other drugs or foods, necessitating careful monitoring and adjustment of treatment regimens.

In conclusion, the wide array of antihypertensive drugs available today offers healthcare providers the flexibility to tailor treatment to each patient's specific needs. 

Antihypertensive Drugs_ A Comprehensive Classification

Antihypertensive Drugs: A Comprehensive Classification

Antihypertensive drugs are a diverse group of medications used to manage high blood pressure, a condition that affects millions of people worldwide and is a major risk factor for cardiovascular diseases. These drugs are classified into several groups based on their mechanisms of action and effects on the cardiovascular system. Understanding these classifications is crucial for healthcare professionals to effectively tailor treatment strategies for individual patients.

The first major group is Angiotensin-Converting Enzyme (ACE) Inhibitors. These drugs work by blocking the production of angiotensin II, a potent vasoconstrictor. By reducing the levels of angiotensin II, ACE inhibitors promote vasodilation and decrease blood pressure. Common examples include lisinopril, enalapril, and ramipril. ACE inhibitors are particularly beneficial for patients with diabetes or heart failure due to their cardioprotective effects.

Angiotensin II Receptor Blockers (ARBs) form the second group. Unlike ACE inhibitors, ARBs directly block the action of angiotensin II at its receptor sites. This results in similar effects to ACE inhibitors but with a different mechanism. Losartan, valsartan, and irbesartan are widely prescribed ARBs. These drugs are often used as alternatives for patients who cannot tolerate ACE inhibitors due to side effects like cough.

Calcium Channel Blockers (CCBs) constitute the third major group. These medications prevent calcium from entering the smooth muscle cells of blood vessels and the heart, leading to vasodilation and reduced cardiac workload. CCBs are further divided into dihydropyridines (e.g., amlodipine, nifedipine) and non-dihydropyridines (e.g., verapamil, diltiazem). Dihydropyridines primarily affect blood vessels, while non-dihydropyridines have additional effects on heart rate and conduction.

Beta-Blockers form the fourth group of antihypertensive drugs. These medications work by blocking the effects of epinephrine (adrenaline) on beta receptors in the heart and blood vessels. This action results in a decreased heart rate and cardiac output, thereby lowering blood pressure. Common beta-blockers include metoprolol, atenolol, and propranolol. They are particularly useful in patients with coronary artery disease or heart failure.

Diuretics, the fifth group, act by increasing urine production and sodium excretion, which leads to a reduction in blood volume and, consequently, blood pressure. There are three main subclasses: thiazide diuretics (e.g., hydrochlorothiazide), loop diuretics (e.g., furosemide), and potassium-sparing diuretics (e.g., spironolactone). Thiazide diuretics are often used as first-line treatments for hypertension due to their effectiveness and low cost.

The sixth group comprises Alpha-Blockers, which work by blocking alpha receptors in blood vessels, causing vasodilation. Examples include doxazosin and prazosin. While not typically used as first-line treatments, they can be beneficial in certain patient populations, such as those with benign prostatic hyperplasia.

Direct Vasodilators form the seventh group. These drugs act directly on blood vessel walls to cause relaxation and dilation. Hydralazine and minoxidil are examples of this class. They are often reserved for resistant hypertension or used in combination with other antihypertensive medications.

The final group includes Centrally Acting Agents, which work on the central nervous system to reduce sympathetic outflow, thereby lowering blood pressure. Clonidine and methyldopa are examples of this class. These drugs are less commonly used due to their side effect profile but can be valuable in specific clinical scenarios.

In practice, many patients require a combination of antihypertensive drugs from different classes to achieve optimal blood pressure control.