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The results of basic and clinical research in hypertension over the last 30 years have shown that this disease cannot be treated merely by inducing vasodilation and a fall in blood pressure. The development of high blood pressure is associated with changes in carbohydrate and lipid metabolism and with the development of organ damage, mainly of the heart and kidneys. It is now clear that different elements of blood pressure control mechanisms can lead to hypertension, emphasizing the need to select the appropriate type of hypertensive drug in treating different patients.Calcium channel antagonists and ACE inhibitors have synergistic effects on sodium and fluid balance and on the renin–angiotensin–aldosterone system. Thus a combination of these two antihypertensive drug classes is likely to be beneficial in certain subgroups of patients with hypertension. Large clinical trials are needed to determine whether this is indeed the case.