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Coronary heart disease in hypertensives: a need to reduce cholesterol
S Heyden1, K A Schneider, G J Fodor
1Department of Community and Family Medicine, Duke University Medical Centre, Durham, NC 27710.
Insights
Antihypertensive treatments effectively reduced stroke incidence but not coronary heart disease (CHD). Combining cholesterol-lowering therapy with blood pressure medication significantly decreased CHD in hypertensive patients.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Long-term hypertension intervention trials (1980-1987) significantly reduced stroke incidence.
- However, most trials showed limited success in preventing coronary heart disease (CHD).
- High baseline cholesterol levels were common, and cholesterol treatment was often absent, correlating with high CHD incidence.
Purpose of the Study:
- To investigate the impact of cholesterol levels on the efficacy of antihypertensive treatments for CHD prevention.
- To evaluate the combined effect of antihypertensive and cholesterol-lowering therapies on CHD incidence.
Main Methods:
- Analysis of ten international long-term hypertension intervention trials.
- Stratification of participants based on baseline cholesterol levels in some trials.
- Examination of the Gothenburg trial, which combined antihypertensive and cholesterol-lowering treatments.
Main Results:
- Eight of ten trials failed to significantly reduce CHD incidence despite lowering blood pressure.
- Trials with lower baseline cholesterol showed less CHD.
- The Gothenburg trial demonstrated a marked reduction in CHD when combining blood pressure and cholesterol-lowering treatments.
Conclusions:
- Failure to address hypercholesterolemia may explain the limited efficacy of antihypertensive drugs in preventing CHD.
- Treating hypercholesterolemia in hypertensive patients is crucial for reducing CHD incidence.
- Successful cholesterol management could equalize CHD reduction in hypertensive and normotensive individuals.
Abstract:
Ten international long-term hypertension intervention trials between 1980 and 1987 have resulted in significant reduction in the incidence of stroke in the treatment groups. Yet, eight of these studies have shown disappointing results in the prevention of coronary heart disease (CHD). Five hypertension intervention trials revealed high average cholesterol values at baseline. No cholesterol treatment was provided and the incidence of CHD was high. In four other trials with stratification into 'low' and 'high' baseline cholesterol levels, the incidence of CHD was considerably less in the 'low' cholesterol groups. Only the 10th, the Gothenburg trial, has demonstrated a marked reduction in CHD by combining antihypertensive medication with cholesterol lowering treatment. Failure to reduce cholesterol in hypertensives with hypercholesterolaemia may be one explanation for the limited efficacy of antihypertensive treatment in the reduction of CHD. We postulate that successful treatment of hypercholesterolaemia will reduce the incidence of CHD in well-controlled hypertensive patients to the same extent as it lowers the incidence of CHD in normotensive people.