[Controversies in the treatment of arterial hypertension: other drugs as the first step (calcium antagonists, ACE inhibitors and alpha-blockers)].

This paper is the written version of the conference that under the same title was presented in the XXX Congreso Nacional de la Sociedad Española de Cardiología. In the paper, the use of the most recent antihypertensive drugs is advocated as first line therapy. The defence is based in cardiac and non cardiac considerations. Among the former, there are certain advantages of the new drugs in areas as regression of left ventricular hypertrophy and improvement of coronary flow and coronary reserve. Among the non cardiac considerations there are some metabolic factors (non adverse effect on the lipid profile), as well as a positive effect on some endocrine-metabolic cascades like the insulin-resistance syndrome and a very important role in certain special situations as coexistence with other diseases and individual characteristics of the patient (pregnancy or elderly for example).