Since 1957, thiazide-type diuretics have been used to treat patients with uncomplicated hypertension, either alone or in combination with drugs from other classes. These help the kidneys flush excess water and salt from the body. With less fluid in the blood, blood volume and pressure are reduced.
In 1984, ACE inhibitors were developed to prevent the body from making the hormone angiotensin II, which causes blood vessels to constrict. Indicated for more high-risk patients, this drug class gained favor quickly.
Angiotensin II receptor blockers (ARBs) came on the market in 1995 to protect blood vessels from angiotensin II-relaxing and widening blood vessels and lowering blood pressure. Because they cause fewer side effects, ARBs quickly became an alternative to ACE inhibitors as the antihypertensive therapy of choice.
This trend runs counter to the recommendation by the National Heart, Lung and Blood Institute of the National Institutes of Health, which suggests that tried-and-true diuretics should be the go-to medication for patients with hypertension.