Hypertension, antihypertensive drugs, and atherogenesis. Mechanisms and clinical implications

This paper briefly reviews the current knowledge regarding the effects of hypertension and of antihypertensive drugs on the arterial wall and their possible influence on atherogenesis. The potential clinical implications of the experimental data are discussed, and the following recommendations are made regarding therapy of the hypertensive patient: 1) Management of associated hyperlipoproteinemia, even if mild, would appear to be essential in the hypertensive patient because hypertension does not appear to promote atherosclerosis appreciably when plasma cholesterol levels are low. 2) In the mild hypertensive with diastolic blood pressure from 90-95 mmHg without associated target-organ damage or other major risk factors, treatment of the hypertension should primarily be nonpharmacologic in nature. 3) Hypertensive subjects receiving antihypertensive drugs that can have an adverse effect on plasma lipoproteins should have plasma lipids monitored closely; if unfavorable effects occur, revision of therapy should be considered. 4) Major attempts should be made to reduce other risk factors as well, particularly smoking. 5) Because of inherent difficulties in reversing atherosclerosis, treatment of hypertension and other abnormal risk factors should be instituted early in life before severe disease has developed. Finally, research efforts should intensified to delineate the mechanisms by which hypertension and antihypertensive drugs affect the arterial wall and to develop new approaches for protection against arterial injury.