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The treatment of hypertension: a therapeutic philosophy for the 1990s
1Department of Medicine and Therapeutics, University of Glasgow, Scotland.
Insights
Current blood pressure drugs effectively prevent stroke and heart failure but not coronary artery disease. Future hypertension treatments should integrate lifestyle changes and consider low-dose drug combinations for better cardiovascular disease prevention.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Antihypertensive medications are effective in reducing stroke and renal failure but show limited impact on coronary artery disease (CAD).
- Understanding of genetic and environmental factors in atherosclerosis and CAD is improving, alongside recognition of risk factor interactions.
Purpose of the Study:
- To emphasize the need for hypertension management to be part of a comprehensive cardiovascular disease prevention strategy.
- To explore future directions in antihypertensive drug treatment, focusing on complementary approaches and combination therapies.
Main Methods:
- Review of current antihypertensive drug efficacy and limitations.
- Analysis of established and emerging risk factors for atherosclerosis and CAD.
- Consideration of integrated approaches including lifestyle modifications and pharmacotherapy.
Main Results:
- Existing antihypertensive drugs have a suboptimal effect on CAD.
- Integrated prevention strategies combining lifestyle changes (smoking cessation, alcohol control) and treatment of hypertension and hyperlipidemia are crucial.
- Pharmacologically coherent low-dose combinations of antihypertensive drugs are likely to play a future role.
Conclusions:
- Hypertension management must be integrated into a broader cardiovascular disease prevention and health promotion framework.
- Future antihypertensive therapies should be well-tolerated, effective, and complement other preventive measures.
- Combination therapy with low-dose antihypertensive drugs may offer a more successful approach for many patients.
Abstract:
To date, a range of drugs are available that are generally well tolerated and effective in lowering blood pressure. Although they are successful in reducing stroke, renal failure, and cardiac failure, they have a disappointing and less than expected influence on coronary artery disease and its manifestations. The genetic and environmental factors determining susceptibility to atherosclerosis and coronary artery disease are now more clearly defined and interactions between risk factors and protective mechanisms recognized. Drug treatment of hypertension must become a part of the overall approach to prevention of cardiovascular disease and possible health promotion. Dietary and hygienic measures (cessation of smoking and control of alcohol intake) should be combined where necessary with specific treatment of hypertension and hyperlipidemia. Future drug treatment must not only be effective and well tolerated but should complement other preventive approaches. In view of the increasing recognition that blood pressure treatment with a single drug is unlikely to be successful in all patients, there is likely to be a role in the future for pharmacologically coherent low-dose combinations of antihypertensive drugs.