New insights in the pharmacological therapy of arterial hypertension

Purpose of review Despite the large number of antihypertensive drugs available, their usefulness is limited due to low efficacy, side effects, poor patient compliance and failure to reduce the cardiovascular risk to the level of the general population. These limitations have stimulated the research and development of new anti hypertensive drugs, which we briefly review herein. Recent findings Novel anti hypertensive drugs under development include new oral renin inhibitors, brain aminopeptidase A inhibitors, angiotensin-converting enzyme 2 modulators, short-acting L-type Ca2+ channel blockers, new T-type Ca2+ channel blockers, inhibitors of vascular NAD(P)H oxidase, angiotensin-converting enzyme crosslink breakers, Rho kinase inhibitors, renal Na+/K+ ATPase inhibitors, potassium channel openers and drugs combining different mechanisms of action. Summary Essential hypertension is a multifactorial and multigenic disorder, which means that various mechanisms contribute to a greater or lesser extent to increasing blood pressure. Drugs combining several mechanisms of action or combinations of antihypertensive drugs with those targeting other risk factors may offer an alternative to reduce overall cardiovascular risk. As we improve our understanding of essential hypertension, it should be possible to develop safer and more effective anti hypertensive drugs. The risk/ benefit ratio of these new existing antihypertensive drugs will require long-term endpoint assessment studies.