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Hypertension and vascular disease.

A E Doyle1

  • 1Department of Medicine, University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia.

American Journal of Hypertension
|February 1, 1991
PubMed
Summary

Antihypertensive drug treatment shifts hypertension complications from heart failure and stroke to myocardial infarction. Current evidence does not show blood pressure reduction prevents atherosclerotic complications.

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Area of Science:

  • Cardiology
  • Nephrology
  • Neurology

Background:

  • Antihypertensive drug therapy has significantly altered the clinical presentation of hypertension.
  • Historically, severe untreated hypertension led to congestive heart failure, cerebral hemorrhage, and renal failure.
  • In treated hypertensive patients, myocardial infarction and thrombotic stroke are now the predominant complications.

Purpose of the Study:

  • To evaluate the impact of antihypertensive drug treatment on the natural history and complications of hypertension.
  • To assess whether reducing blood pressure effectively mitigates atherosclerotic complications.
  • To explore the relationship between hypertension, atherosclerosis, and lipoprotein metabolism.

Main Methods:

  • Review of major therapeutic trials in hypertension.
  • Analysis of complications in treated versus untreated hypertensive patients.
  • Examination of experimental animal data on hypertension and atheromatous lesions.

Main Results:

  • Major therapeutic trials have not demonstrated that blood pressure reduction prevents atherosclerotic complications.
  • Hypertension may exacerbate atheromatous lesions, as suggested by animal studies.
  • Elevated serum cholesterol in hypertensive patients might indicate atherosclerosis as the primary issue, with hypertension as a secondary complication.

Conclusions:

  • Antihypertensive treatment has shifted the primary complications of hypertension.
  • Evidence is lacking to support blood pressure reduction as a means to prevent atherosclerosis.
  • The interplay between atherosclerosis, lipoprotein metabolism, and hypertension requires further investigation, potentially re-evaluating hypertension as a secondary complication.

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