Editorial [Hot Topic: Perspectives of New Antihypertensive Drugs (Executive Editor: Ji-Guang Wang)]

Hypertension is one of the most powerful cardiovascular risk factors. By lowering blood pressure, antihypertensive drug treatment reduces the incidence of stroke and coronary heart disease. In general, the currently recommended antihypertensive agents (α-blockers, angiotensin converting-enzyme inhibitors, angiotensin type-1 receptor blockers, β-blockers, calciumchannel blockers, and diuretics) provide similar cardiovascular protection [1]. In randomized controlled trials, the achieved systolic blood pressure largely accounts for cardiovascular outcome, emphasizing the need of tight blood pressure control. The failure in showing the superiority of new antihypertensive drugs (α-blockers, angiotensin converting-enzyme inhibitors, angiotensin type-1 receptor blockers, or calcium-channel blockers) to conventional therapy (diuretics or β-blockers) should not discourage the pharmaceutical industry to invest in developing novel blood pressure lowering agents, because the control rate of hypertension remains low in all communities, particularly for the elevated systolic blood pressure [2]. Indeed, in clinical trials as well as regular clinical practice, hypertensive patients often require 2 to 3 or even more antihypertensive drugs to normalize their systolic and diastolic blood pressure (below 140/90 mm Hg). The emerging basic research provides the potential to develop more potent antihypertensive drugs with a better safety profile. In this issue of Current Pharmaceutical Design, 5 experts and their colleagues give a broad overview on the current status and future perspectives of the development of antihypertensive drugs on the basis of their own work and/or by intense scrutiny of the literature. Magy and colleagues [3] provide a comprehensive review of the recent experimental evidence on the renin-angiotensin system and demonstrate a new concept that angiotensin II and its derivatives are involved in protective mechanisms against cerebral ischemia probably via the non-angiotensin II type 1 receptors. Dr. Quaschning [4] summarizes the vasopeptidase inhibition approach in the treatment of hypertension and heart failure. Dr. Ferrandi and colleagues [5] describe a new antihypertensive pathway and a newly-designed compound, PST 2238, that selectively antagonizes the pressor effect and the alteration of renal Na+-K+ pump and efficiently lowers blood pressure. Dr. Augustyniak and colleagues [6] present a series of experimental work on the role of nitric oxide and nitric oxide synthase in the development of hypertension, and highlight that the nitric oxide pathway is elucidating novel antihypertensive drug targets, in particular for refractory hypertension. Drs Blacher and Safar [7] discuss the role of arterial stiffness measurements in risk assessment as well as in risk reduction strategies by monitoring arterial stiffness under different pharmacological regimens with a blood pressure lowering action. References [1] Staessen JA, Wang JG, Thijs L. Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003. J Hypertens 2003; 21: 1055-76. [2] Gu D, Reynolds K, Wu X, Chen J, Duan X, Muntner P, Huang G, Reynolds RF, Su S, Whelton PK, He J, InterASIA Collaborative Group. The International Collaborative Study of Cardiovascular Disease in ASIA. Prevalence, awareness, treatment, and control of hypertension in china. Hypertension 2002; 40: 920-7. [3] Magy L, Vincent F, Messerli FH, Wang JG, Achard JM, Fournier A. The renin-angiotensin systems : evolving pharmacological perspectives for cerebroprotection. Curr Pharm Design 2005; 11(25): 3275-3291. [4] Quaschning T. Vasopeptidase inhibition for blood pressure control: emerging experience. Curr Pharm Design 2005; 11(25): 3293-3299. [5] Ferrandi M, Barassi P, Molinari I, Torielli L, Tripodi G, Minotti E, Bianchi G, Ferrari P. Ouabain antagonists as antihypertensive agents. Curr Pharm Design 2005; 11(25): 3301-3305. [6] Augustyniak RA, Thomas GD, Victor RG, Zhang W. Nitric oxide pathway as new drug targets for refractory hypertension. Curr Pharm Design 2005; 11(25): 3307-3315. [7] Blacher J, Safar ME. Large artery stiffness and antihypertensive agents. Curr Pharm Design 2005; 11(25): 3317-3326.