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Risk-benefit aspects of antihypertensive drugs
1University of Munich, Medizinische Poliklinik, Germany.
Insights
Traditional high blood pressure treatments with diuretics and beta-blockers reduce cardiovascular risks but don't eliminate them. These drugs may worsen lipid metabolism, increasing coronary heart disease risk and explaining limited success in preventing heart attacks.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Hypertension Research
Background:
- Traditional antihypertensive therapies, including diuretics and beta-blockers, have demonstrated efficacy in reducing overall cardiovascular complications.
- Despite treatment, hypertensive patients retain higher cardiovascular risk compared to normotensive individuals.
- While effective for cerebrovascular complications (65% reduction), these therapies show disappointing results for coronary events, which are more prevalent in hypertensive patients.
Purpose of the Study:
- To evaluate the long-term impact of traditional antihypertensive agents on cardiovascular risk.
- To investigate the reasons behind the limited effectiveness of current therapies in preventing coronary events.
- To highlight the potential adverse effects of diuretics and beta-blockers on lipid metabolism and their implications for coronary heart disease.
Main Methods:
- Analysis of long-term clinical trial data on traditional antihypertensive therapy.
- Assessment of the impact of diuretics and beta-blockers on lipid metabolism.
- Comparison of the incidence of cerebrovascular versus coronary events in treated hypertensive patients.
Main Results:
- Long-term use of diuretics and beta-blockers can lead to persistent adverse effects on lipid metabolism, creating a new risk factor for coronary heart disease.
- These metabolic alterations may partially explain the failure of traditional therapies to effectively reduce myocardial infarction and sudden death rates.
- Dose titration to minimize side effects often results in subtherapeutic drug levels, particularly for hydrochlorothiazide.
Conclusions:
- Traditional antihypertensive drugs, while beneficial for cerebrovascular events, have limitations in preventing coronary events due to adverse metabolic effects.
- The debate on optimal first-line antihypertensive agents remains unresolved pending comparative trials with newer agents.
- Further research is needed to identify antihypertensive strategies that effectively reduce cardiovascular risk without negatively impacting lipid profiles.
Abstract:
Several long term trials using traditional antihypertensive therapy with diuretics and beta-blockers have shown that antihypertensive therapy reduces the overall risk of cardiovascular complications. However, even after several years of therapy the cardiovascular risk in hypertensive patients cannot be lowered to that in the normotensive population. Antihypertensive therapy can reduce the incidence of cerebrovascular complications in patients with hypertension by about 65%. However, the effect of such therapy in preventing coronary events has been disappointing, as these events are 3 to 4 times more common than cerebrovascular complications in hypertensive patients. It is now apparent that adverse pharmacological effects of diuretics and beta-blockers on lipid metabolism persist for many years. Thus, treatment with these agents constitutes a new risk factor for coronary heart disease and may, at least in part, explain the failure of traditional antihypertensive therapy to reduce the incidence of myocardial infarction and sudden death as effectively as that of cerebrovascular accidents. On the other hand, titration of these antihypertensive agents to the lowest possible dose in order to avoid metabolic alterations and subjective adverse effects has frequently resulted in the administration of subtherapeutic doses, particularly for hydrochlorothiazide. Until comparative long term clinical trials with older and newer antihypertensive agents and morbidity and mortality as end-points are completed, the debate on first-line drugs for antihypertensive treatment will not be satisfactorily resolved.