Prevention of myocardial infarction

There is a significant relationship between high blood pressure and a variety of other risk factors for coronary heart disease. Antihypertensive treatment reduces the incidence of coronary heart disease, but at a lower level than expected from epidemiological data. It is proposed that there is an alternative route to coronary heart disease from a 'factor X' via various metabolic disturbances, in addition to the route via hypertension. There have been a number of trials comparing the effects of diuretics with beta-blockers in the treatment of hypertension. However, the number of endpoints is very small in these trials, making it difficult to conclude that there is any difference between the effects of the two types of drug on patients. In contrast, in post-myocardial infarction trials, where the number of endpoints was much larger, beta-blockers had a positive effect. Thus larger antihypertensive drug trials are needed to study the effect of beta-blockers in primary prevention.