Hypertension to Heart Failure: New Developmental Strategies do not Cross a Clinical and Therapeutic Divide

Management of hypertension has evolved steadily through 25 years of major clinical trials results modifying both the definition of hypertension and clinical management strategies. Trials experience in heart failure is much less extensive given the far smaller therapeutic market and traditionally often followed on the establishment of an agent or class of therapy in hypertension. Separate product profile development in heart failure is rare. Large outcome trials in heart failure are markedly smaller than those in hypertension and have tended to be confined to the last 15 years or so. There are clear examples of agents developed and successful in clinical use in both conditions but more recently the divergence of trials results in the two conditions has shown that comparable efficacy is no longer something which can be taken for granted. This review considers the past successes and more recent contrasts which have emerged in these traditional areas of pharmacological development.