ABSTRACT
Hypertension is often thought of as a silent killer. Although elevated blood pressure (BP) is usually asymptomatic, increased diastolic blood pressure (DBP) is associated with increased risk of both stroke and coronary heart disease (CHD; MacMahon et al., 1990). Individuals with naturally occurring low BP are at the lowest risk for developing cardiovascular (CV) disease, and pharmacologically lowering BP has been shown to decrease the risk of future complications such as stroke and CHD (Collins et al., 1990). Over the last 20 years, the number of available treatments for hypertension has increased dramatically. For the purposes of lowering BP, physicians can prescribe beta adrenergic antagonists (beta blockers [BBs]), angiotensin converting enzyme (ACE) inhibitors, calcium antagonists (calcium channel blockers [CCBs]), peripheral adrenergic inhibitors, central alpha agonists, combined alpha and beta blocking agents, direct vasodilators, and diuretics. In the United States, diuretics remain the most frequently prescribed medications to treat hypertension, although with the advent of CCBs and ACE inhibitors, their use has been steadily decreasing (Kaplan, 1998).
