Management of hypertension: is it the pressure or the drug? Blood Pressure Reduction Is Not the Only Determinant of Outcome

Whether certain classes of antihypertensive drugs confer benefits beyond those associated with lowering blood pressure remains a highly controversial issue. Data from several meta-analyses have been used to support the notion that most, if not all, of the cardiovascular benefits reported with the use of different classes of antihypertensive drugs are simply a consequence of the extent to which they lower blood pressure. However, we submit evidence in this review that the diverse pharmacological actions of several antihypertensive medications may have benefits beyond their blood pressure–lowering effects and that, in the case of certain classes of drugs, notably -blockers, adverse metabolic effects of these drugs may actually mitigate the potential benefits of blood pressure lowering.