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Does hypertension predispose to coronary disease? Conflicting epidemiological and experimental evidence
1University of Melbourne, Department of Physiology, Parkville, Victoria, Australia.
Insights
Hypertension increases coronary event risk, but treatment trials show no reduction in these events, though stroke risk decreases. The study suggests an association, not causation, between hypertension and coronary disease.
Area of Science:
- Cardiovascular Medicine
- Clinical Hypertension Research
Background:
- Hypertension is a known risk factor for cardiovascular events.
- Previous studies indicate hypertension treatment reduces stroke but not necessarily coronary events.
Purpose of the Study:
- To investigate the relationship between hypertension and coronary events.
- To analyze mortality patterns in treated versus untreated hypertension.
- To examine the correlation between blood pressure and coronary atherosclerosis.
Main Methods:
- Review of controlled trials on hypertension treatment.
- Analysis of death causes in untreated and treated hypertensive patients.
- Autopsy findings on coronary atherosclerosis in hypertensive individuals.
Main Results:
- Hypertension treatment reduced stroke incidence but not coronary events.
- In untreated hypertension, heart failure was the primary cause of death; in treated hypertension, coronary events accounted for a significant portion of deaths.
- No direct correlation was found between blood pressure levels and the severity of coronary atherosclerosis.
Conclusions:
- The findings suggest an association between hypertension and coronary disease, rather than hypertension being a direct causal factor.
- The etiological factors for acute myocardial infarction may differ from those leading to coronary atherosclerosis.
- Further research is needed to elucidate the complex interplay between hypertension, coronary atherosclerosis, and myocardial infarction.
Abstract:
Hypertension is associated with an increased risk of coronary events. Treatment of hypertension in controlled trials has not reduced the incidence of coronary events, although the risk of stroke is reduced. In untreated hypertension, about one-half the deaths were due to hypertensive heart failure, whereas myocardial infarction caused 10%-12% of deaths. In treated hypertension, coronary events cause about 40% of deaths. Although in autopsy serious coronary atherosclerosis is commonly found in hypertension, in severe hypertension, dilated coronary vessels free of atheroma were a common finding. No correlation was noted between the height of blood pressure and degree of coronary atherosclerosis. The relationship between coronary disease and hypertension is consistent with an association between them rather than hypertension being a causal factor. The factors that cause acute myocardial infarction may differ from those which predispose to coronary atherosclerosis.