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[Effect of alpha inhibitors on risk cofactors in patients with hypertension]
1Service de Médecine-Hypertension artérielle, Hôpital Broussais, Paris.
Insights
Diuretics and beta-blockers effectively treat hypertension but do not prevent heart attacks. Alpha-blockers may offer better cardiac protection for hypertensive patients with high lipids or smoking risks.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Hypertension treatment aims to prevent cardiovascular events.
- Diuretics and beta-blockers lower blood pressure but show limited cardiac protection.
- Associated risk factors like hyperlipidemia and smoking are prevalent in hypertensive patients.
Purpose:
- To evaluate the efficacy of different antihypertensive drug classes in managing cardiovascular risk.
- To investigate the impact of diuretics, beta-blockers, and alpha-blockers on lipid metabolism and smoking interactions.
- To assess the potential benefits of alpha-blockers in high-risk hypertensive patients.
Summary:
- Diuretics and beta-blockers, while effective for blood pressure control and stroke prevention, do not reduce myocardial infarction or coronary death rates.
- These traditional agents can negatively impact lipid metabolism and interact unfavorably with smoking.
- Alpha-blockers do not adversely affect serum lipids and may even improve them, showing potential benefits in smokers.
Impact:
- Alpha-blockers may be a preferable treatment option for hypertensive individuals with hyperlipidemia and smoking habits.
- Further large-scale, long-term trials are necessary to confirm the cardiovascular risk reduction capabilities of alpha-blockers.
Abstract:
Treatment of hypertension aims at preventing strokes and coronary events although diuretics and beta-blockers lowered blood pressure effectively and allowed prevention of strokes in large-scale trials, they did not reduce the incidence of myocardial infarction or coronary death. The failure of diuretics and beta-blockers to afford cardiac protection may be due in part to the unfavorable effects of these agents on associated risk factors like hyperlipidemia and smoking. Hyperlipidemia is more prevalent in hypertensive patients than in matched normotensive controls, and the combination of hyperlipidemia and smoking is more frequent than can be expected to occur by chance. Diuretics and beta-blockers affect lipid metabolism negatively. Unlike these agents, alpha-blockers do not alter serum lipids and might reduce triglyceride and cholesterol levels. Several trials have shown that the outcome of treatment with beta-blockers was less favorable in smokers than in non-smokers in terms of blood pressure control and prevention of coronary events. A possible explanation is provided by acute experiments in which beta-blockade enhanced the systemic and coronary vasocontriction elicited by smoking, while alpha-blockade had the opposite effect. Although there is reason to believe that alpha-blockers may be preferable to diuretics and beta-blockers for the treatment of high risk hypertensive patients who smoke and/or exhibit high levels of serum lipids, there is a need for larger and longer trials to test their ability to reduce cardiovascular risk.