The interplay of ischemic and hypertensive pathophysiology on cardiac function

Many patients with systemic hypertension also have concomitant angina pectoris. Hypertension is a risk factor for the development of coronary artery disease as well as an aggravating factor once symptomatic ischemic heart disease develops. It would be prudent to use one agent that reduced the elevated blood pressure and relieved anginal symptoms while providing no negative affects on hemodynamics or other cardiac risk factors. beta-Adrenergic blockers (traditional agents and newer compounds with ancillary properties) and calcium-entry blockers have been shown to be effective as monotherapies in patients with angina. They also have the ability to induce left ventricular hypertrophy regression. There is some evidence that some of these therapies may arrest the development of arteriosclerosis and may have an inhibitory effect on platelet aggregation. What remains controversial is the optimal amount of blood pressure reduction in patients with hypertension coexistent with angina, or whether one specific agent or drug class would have an overall advantage in reducing the risk of morbidity or mortality.