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Management of multiple risk factors for coronary heart disease in patients with hypertension
1Hypertension Clinic, St. Mary's Hospital, London, England.
Insights
Hypertension treatments using diuretics and beta-blockers show limited coronary heart disease (CHD) benefits. Optimal hypertension management requires addressing multiple risk factors, not just blood pressure.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Hypertension intervention trials using diuretics and beta-blockers have yielded disappointing results in reducing coronary heart disease (CHD).
- Elevated blood pressure, high cholesterol, and smoking are prevalent risk factors for CHD, often clustering in hypertensive patients.
Purpose of the Study:
- To review current hypertension therapies and their impact on coronary heart disease.
- To advocate for a multifactorial approach in managing hypertension, considering all CHD risk factors.
Main Methods:
- Review of existing hypertension intervention trial data.
- Analysis of the impact of common antihypertensive agents on cardiovascular risk factors.
Main Results:
- Diuretics and beta-blockers demonstrate limited efficacy in reducing CHD.
- These agents can negatively impact serum lipid profiles, potentially offsetting blood pressure-lowering benefits.
Conclusions:
- Current antihypertensive therapies may not be optimal for CHD prevention.
- A comprehensive, multifactorial treatment strategy is necessary for effective hypertension and CHD risk management.
Abstract:
Hypertension intervention trials, which have involved mainly the use of diuretics and beta-blockers, have demonstrated a disappointing benefit in terms of reduction of coronary heart disease (CHD). Rather than suggesting that elevated blood pressure and CHD are not causally related, these data suggest that the antihypertensive agents used were not optimal for the management of hypertension and a review of the currently recommended therapies is needed. Major risk factors for CHD, which include increased blood pressure, elevated serum cholesterol levels, and smoking, are highly prevalent in the general population and appear to cluster in patients with hypertension. Therefore the treatment of hypertension demands a multifactorial approach, one that takes into consideration all the risk factors for CHD. Diuretics and beta-blockers adversely affect the serum lipid profile, and this could negate some of the CHD benefit afforded by blood pressure reduction.