New frontiers in drug therapy for arterial hypertension

Hypertension currently shows an overwhelming epidemiologic status, with an approximate world prevalence of 31.1%, and representing one of the main modifiable risk factors for cardiovascular disease. Furthermore, only one third of the hypertensive population appears to maintain adequate disease control, suggesting that there are important gaps in the reach, efficacy, and safety of the currently available pharmacotherapeutic arsenal. In this scenario, in recent years there has been seen the proposal of innovative pharmacologic alternatives which may aid this necessity in some degree. Each year, new pharmacologic targets are identified, originating a constant influx of new research in this field. These drugs include various types of anti-aldosterone agents, activators of the angiotensin converting enzyme 2-angiotensin(1-7)-Mas system, inhibitors of aminopeptidases, neprilysin and endothelin converting enzyme, among many others. Nevertheless, it should be noted that to date, evidence remains insufficient to include any of these options in the formal treatment schemes for hypertension; and clinical experimentation remains key, especially concerning safety, tolerability, and long-term adverse effects. This review summarizes and comments on current preclinical and clinical information on novel, recently-proposed classes of antihypertensive drugs.