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Beyond blood pressure control. Effect of antihypertensive therapy on cardiovascular risk factors
1UCLA School of Medicine, Los Angeles, CA 90024.
Insights
Treating mild hypertension reduces mortality and stroke risk. However, some blood pressure medications may worsen metabolic factors, hindering coronary heart disease (CHD) prevention. ACE inhibitors and calcium channel blockers offer a better approach.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Hypertension Management
Background:
- Mild hypertension contributes significantly to high blood pressure-related mortality.
- Cardiovascular risk factors include left ventricular hypertrophy (LVH), dyslipoproteinemia, and glucose intolerance.
- The impact of antihypertensive treatments on these risk factors is crucial.
Purpose of the Study:
- To evaluate the effects of antihypertensive agents on cardiovascular risk factors.
- To investigate why some treatments fail to reduce coronary heart disease (CHD) risk despite lowering blood pressure.
- To identify antihypertensive agents with favorable metabolic profiles.
Main Methods:
- Analysis of large therapeutic intervention trials.
- Comparison of metabolic side effects of different antihypertensive drug classes.
- Assessment of impact on all-cause mortality, stroke, congestive heart failure, and coronary heart disease (CHD).
Main Results:
- Adequate treatment of mild hypertension reduces all-cause mortality, stroke, and heart failure.
- Common agents like diuretics and beta-blockers may cause adverse metabolic effects (hypercholesterolemia, hyperglycemia, hypokalemia).
- These side effects might offset benefits, failing to reduce coronary heart disease (CHD) risk.
- Angiotensin-converting enzyme inhibitors (ACEIs) and calcium channel blockers lack these adverse metabolic derangements.
Conclusions:
- Antihypertensive agents with neutral or favorable metabolic effects may further decrease cardiovascular morbidity and mortality.
- Selecting medications that avoid adverse metabolic changes is key to comprehensive cardiovascular risk reduction.
- Optimizing hypertension treatment can improve outcomes, including reducing coronary heart disease (CHD) risk.
Abstract:
Mild hypertension accounts for approximately 60% of the mortality associated with high blood pressure. In addition to hypertension, other major cardiovascular risk factors include left ventricular hypertrophy (LVH), dyslipoproteinemia, and glucose intolerance. Thus, the effects of agents used to treat hypertension on these risk factors are of considerable importance. Large therapeutic intervention trials have shown that while adequate treatment of mild hypertension significantly and consistently reduces all-cause mortality as well as the risk of stroke and congestive heart failure, an anticipated reduction in coronary heart disease (CHD) has not been demonstrated. It is possible adverse metabolic side effects (hypercholesterolemia, hyperglycemia, hypokalemia) of widely used agents, such as diuretics and beta-blockers may be partially offsetting the beneficial effects of blood pressure reduction, with the net result being a failure of these agents to reduce the risk of CHD. Angiotensin-converting enzyme inhibitors (ACEIs) and calcium channel blockers do not produce these adverse metabolic derangements. The use of antihypertensive agents that have favorable or neutral metabolic effects should further reduce the risk of cardiovascular morbidity and mortality attributable to high blood pressure, including CHD.