Related Experiment Videos
Cardiovascular effects of antihypertensive drugs--involvement in the therapeutic choice
M Luque-Otero1, C Fernandez-Pinilla
1Hypertension Unit, Hospital Universitario San Carlos, Complutense University, Madrid, Spain.
Insights
Hypertension treatment effectively reduces cerebrovascular deaths but not cardiovascular mortality. Metabolic side effects of some blood pressure medications may counteract their benefits, impacting heart health outcomes.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Hypertension Research
Background:
- Hypertension significantly elevates risks for cerebrovascular and cardiovascular diseases.
- While treatments have reduced cerebrovascular mortality, cardiovascular mortality, particularly from myocardial infarction, remains a concern.
- The potential for antihypertensive medications to cause metabolic side effects that offset blood pressure reduction benefits is a key area of investigation.
Purpose of the Study:
- To investigate the impact of long-term antihypertensive therapy on vascular resistance and structure in patients with established hypertension.
- To explore whether metabolic side effects of antihypertensive drugs contribute to cardiovascular mortality despite blood pressure control.
Main Methods:
- Analysis of long-term effects of various antihypertensive drug classes (diuretics, calcium antagonists, ACE inhibitors, alpha blockers) on vascular resistance.
- Examination of structural changes in resistance vessels, including wall-to-lumen ratio, smooth muscle hypertrophy, and extracellular matrix composition (elastin, collagen).
Main Results:
- Long-term diuretic therapy and dihydropyridine calcium antagonists, vasodilators, angiotensin-converting enzyme inhibitors, and alpha blockers decrease total peripheral resistance.
- Hypertension is associated with increased wall-to-lumen ratio in resistance vessels due to smooth muscle hypertrophy and increased elastin and collagen.
- Antihypertensive therapy positively impacts small resistance vessels but shows variable effects on large arteries.
Conclusions:
- Antihypertensive medications can reduce vascular resistance, particularly in small vessels, which is beneficial for managing hypertension.
- The persistent cardiovascular mortality despite reduced cerebrovascular deaths highlights the need to consider drug-specific metabolic effects and their impact on overall cardiovascular outcomes.
- Further research is needed to fully understand the variable effects on large arteries and to mitigate potential adverse cardiovascular events associated with hypertension management.
Abstract:
Hypertensive patients are at an increased risk of developing cerebrovascular and cardiovascular disease. Treatment has resulted in a substantial reduction in cerebrovascular deaths but not in cardiovascular mortality. As the number of deaths from myocardial infarction exceeds the sum of all other hypertension-related mortalities, these results are disappointing. The hypothesis that metabolic side effects of many antihypertensive drugs offset the potential benefit of decreasing blood pressure is of particular interest. In established hypertension there is an increase in total peripheral resistance. Long-term therapy with diuretics decreases vascular resistance. This is also evident with dihydropyridine calcium antagonists, vasodilators, angiotensin-converting enzyme inhibitors and alpha blockers. In patients with hypertension, an increased wall to lumen ratio occurs in resistance vessels where mechanisms such as smooth muscle hypertrophy and increased amounts of elastin and collagen are present. In small resistance vessels, long-term antihypertensive therapy has a positive effect, but the effect in large arteries is variable.