A new study suggests olmesartan may achieve regression of atherosclerosis

endorse the five major classes of antihypertensives – thiazide diuretics, calcium antagonists, ACE inhibitors, angiotensin receptor antagonists and betablockers – as being suitable for the initiation and maintenance of antihypertensive treatment, alone or in combination. Further, they state that because more than one drug is needed by many patients, there is a futility in emphasising the first class of drugs to be used. Evidence exists for the benefits of each of the drugs we use, although some classes are more appropriate or effective in different ethnic groups or in those with co-morbidities and concurrent prescribing. However, some national societies make it simpler for the primary care team by being more specific. For example, the latest British Hypertension Society (BHS) guidelines specifically recommend drug therapy in all patients with sustained systolic pressures of > 160 mmHg or sustained diastolic pressures > 100 mmHg despite lifestyle measures, and in patients with sustained systolics of 140–159 mmHg or diastolics of 90–99 mmHg where target organ damage is present or where there is evidence of established cardiovascular disease, diabetes or a raised 10-year CHD risk. Beta-blockers have fallen from favour as Introduction F aced with a wide variety of therapies on offer in hypertension management and differences in the available guidelines, although endorsing all therapeutic groups, it can be useful to consider differences that may mean some drugs are more useful than others in certain patients. Age, ethnic group, concurrent pathology, cost and interactions with other therapies will affect our choice. A new study suggests that an angiotensin receptor antagonist, olmesartan, may offer the added benefit of reversing atherosclerotic plaque development. Using a new method for measuring intima media thickness (IMT) – non-invasive 3D ultrasound imaging of the carotid arteries – the Multicentre Olmesartan atherosclerosis Regression Evaluation (MORE) study showed a significant reduction in plaque size in hypertensive patients with known atherosclerosis who were treated with olmesartan for two years. This is a small, preliminary study, but raises the possibility of reversal of atherosclerosis with a drug that is currently used to reduce raised blood pressure.