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Treatment of high blood pressure--the effect on coronary morbidity and mortality
J L Reid1, J L Curzio, S Kennedy
1University Department of Materia Medica, Stobhill General Hospital, Glasgow, Scotland, UK.
Insights
Established hypertension drugs reduce stroke but not coronary disease. Improved blood pressure control is key, alongside managing multiple risk factors like high cholesterol and smoking, for better outcomes in hypertensive patients.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Public Health
Background:
- Established antihypertensive drugs effectively reduce stroke incidence.
- These treatments show limited impact on coronary artery disease (CAD) and its complications.
- Potential reasons include suboptimal blood pressure (BP) reduction, overestimation of BP's role versus other risk factors, or adverse effects of existing medications.
Purpose of the Study:
- To evaluate the effectiveness of current hypertension treatments on cardiovascular outcomes.
- To explore the impact of multiple risk factors in hypertensive patients.
- To investigate the potential benefits of alternative drug therapies targeting lipid profiles.
Main Methods:
- Analysis of outcomes in patients treated for hypertension.
- Assessment of cardiovascular risk factors including smoking, serum cholesterol, and blood glucose.
- Monitoring of blood pressure control and its correlation with patient outcomes.
Main Results:
- Mortality remains higher in treated hypertensives compared to normotensives, with persistent elevated blood pressure.
- Blood pressure during treatment is a stronger predictor of outcomes than baseline BP.
- Despite interventions, smoking habits remained unchanged, while serum cholesterol and blood glucose levels increased in the studied hypertensive population.
Conclusions:
- Improved blood pressure control is crucial for better outcomes in hypertension management.
- A multiple risk factor approach is essential, addressing factors beyond BP, such as high cholesterol and smoking.
- Further research into drugs that modify lipid profiles (total cholesterol, LDL, HDL) is warranted for hypertensive patients.
Abstract:
Established drugs used in the treatment of hypertension have reduced stroke but have had disappointingly little impact on coronary artery disease and its complications. This could be due to inadequate falls in blood pressure (or excessive falls). It is possible that the role of blood pressure in ischaemic heart disease has been over-estimated compared to other risk factors. Alternatively, the drugs used previously may have adversely affected other factors. Mortality in treated hypertensives remains higher than normotensives but so does their blood pressure. The blood pressure on treatment is a much better predictor of outcome than initial blood pressure. This suggests that improved blood pressure control may be desirable. In our hospital-based hypertension clinic many patients have more than one risk factor. In spite of intensive efforts between 1980 and 1988, smoking habits changed little and serum cholesterol and random blood glucose actually rose. Cholesterol is high in our population of hypertensive patients and the mean (+/- SD) rose from 6.4 +/- 1.3 to 6.6 +/- 1.3 (n = 127; P less than 0.01). These observations highlight the importance of a multiple risk factor approach. The benefits of alternative drugs which can lower total cholesterol and/or low-density lipoprotein (LDL) and/or raise high-density lipoprotein (HDL) deserve study in this population. A final possibility is that the widely observed association between hypertension and ischaemic heart disease is not causal (or is weak compared to other risk factors). If a common underlying mechanism caused both atheroma and hypertension then reduction of blood pressure would not be expected to reverse atheroma and its complications. At present this possibility cannot be excluded.