The more one learns, the less one is certain of. This is as true in medicine as in life. Thousands of clinical studies have investigated the effects of hypertension treatments, yet there is still considerable uncertainty about which drugs are most effective.

Meanwhile, many people with no history of cardiovascular disease are being diagnosed with hypertension, and encouraged to take medication for it. But what works best?

The Drugs and Therapeutics Bulletin, a slender but valuable journal, recently published a review of the current evidence on hypertension. There are four main groups of drugs to treat high blood pressure. The first, bendrofluazide, is a diuretic, meaning that urine production is increased, which makes it unpopular with some. Beta-blockers, such as atenolol, are another choice; but these are unsuitable for people with asthma and often trigger side effects, including impotence. Calcium channel blockers such as amlodipine are useful agents but can cause swollen ankles. And ACE inhibitors, such as enalapril, can cause renal problems and require monitoring.

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