First-line and combination treatment for hypertension.

Conventional stepped-care approaches for the control of high blood pressure based on the use of diuretics and beta-blockers have had a disappointing impact on coronary heart disease, the major cause of death in hypertension. Drug therapy for blood pressure should be complementary to attempts to control other risk factors and should not adversely affect other factors. A range of drugs, including calcium antagonists, angiotensin-converting enzyme inhibitors, and alpha-blockers, can be considered as possible first-line treatment. The choice of drug therapy should be individualized and the minimal number of drugs used in the simplest rational regimen. Simple demographic factors and associated diseases, risk factors, and activities should be used to select the most appropriate agents. New combinations offer alternatives for patients who do not receive adequate control with monotherapy.