As a result of concern about the safety and long-term toxicity of diuretics, there is a growing trend toward the use of alternative agents as initial therapy in essential hypertension. Worldwide, beta blockers and vasodilators, especially the calcium-channel blockers, are the most commonly used alternative agents. Several studies comparing these 2 classes of medications are reviewed. These studies indicate that verapamil, nifedipine and diltiazem are all comparable in efficacy to beta blockers. When combined, calcium-channel blockers and beta blockers produce additive responses. These agents may differ in the relation between the magnitude of their antihypertensive effect and patients' pretreatment plasma renin activity and age. Younger persons and those with high plasma renin activity tend to respond better to beta blockers; older subjects and those with low plasma renin activity are more consistently responsive to calcium-channel blockers. The choice of agent should be individualized, based upon accompanying illnesses, adverse-effect profile and demographic factors.