COMPARATIVE ANALYSIS OF NEW GENERATIONS OF HYPOTENSIVE DRUGS AND THEIR CLINICAL IMPORTANCE

Abstract

Hypertension, affecting approximately 1.28 billion adults globally, remains a leading cause of cardiovascular morbidity and mortality. Effective management of this "silent killer" relies heavily on antihypertensive medications, which have evolved significantly over the years. This article provides a comparative analysis of the latest generations of calcium channel blockers (CCBs), focusing on their advancements, clinical effectiveness, safety profiles, and impact on long-term patient outcomes. First-generation dihydropyridine CCBs (e.g., nifedipine) laid the foundation but were limited by short duration, reflex tachycardia, and side effects like peripheral edema. Second-generation CCBs (e.g., felodipine) improved targeting, duration, and tolerability. Third-generation agents (e.g., amlodipine) introduced once-daily dosing, superior vascular selectivity, and reduced reflex tachycardia. Fourth-generation CCBs, exemplified by cilnidipine, represent a breakthrough with dual L-type and N-type calcium channel blockade, offering enhanced organ protection, reduced sympathetic activation, and minimal side effects. Clinical studies demonstrate progressive improvements in blood pressure control, with newer generations achieving 25-35% reductions and significantly lower rates of peripheral edema. These advancements are particularly beneficial for elderly patients, diabetics, and those with kidney disease. Future directions include personalized medicine, nanotechnology-based drug delivery, and fifth-generation CCBs with enhanced tissue selectivity. This review highlights the transformative impact of newer antihypertensive drugs, emphasizing their role in optimizing hypertension management and improving patient outcomes worldwide.