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[Benefits and risks of hypertension therapy from the cardiac viewpoint]
1Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität, Düsseldorf.
Insights
Arterial hypertension damages the heart, increasing coronary risks, especially with other factors. Antihypertensive therapy offers significant benefits, outweighing risks, and is crucial for managing cardiac complications.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Context:
- Arterial hypertension is a primary determinant of poor cardiac prognosis.
- Borderline hypertension exacerbates coronary morbidity and mortality, particularly with comorbidities like hypercholesterolemia, diabetes, and smoking.
- Hypertension induces cardiac damage through myocardial hypertrophy, fibrosis, and hypertensive remodeling of coronary microcirculation.
Purpose:
- To review the cardiac organ damages caused by arterial hypertension.
- To evaluate the benefit-risk ratio of antihypertensive therapy in managing cardiac complications.
- To discuss the impact of antihypertensive treatments on left ventricular hypertrophy, coronary flow reserve, and cardiovascular outcomes.
Summary:
- Antihypertensive treatments, including ACE-inhibitors, calcium channel blockers, and beta-blockers, can reverse left ventricular hypertrophy and improve coronary flow reserve.
- Intervention studies indicate a reduction in coronary morbidity and mortality with antihypertensive therapy.
- Specific guidelines for blood pressure management in coronary artery disease (e.g., diastolic pressure not below 85 mm Hg) and considerations for elderly patients are highlighted.
Impact:
- Antihypertensive therapy significantly improves cardiovascular outcomes and reduces the incidence of hypertensive heart failure.
- The findings support the critical role of blood pressure management in preventing and treating hypertensive cardiac damage and associated coronary artery disease.
- Evidence supports the initiation of antihypertensive treatment even in very elderly patients to mitigate cardiac risks.
Abstract:
The poor prognosis of arterial hypertension is mainly determined by its cardiac organ damages. Even borderline arterial hypertension significantly increases coronary morbidity and mortality, particularly in the presence of other risk factors such as hypercholesterolemia, diabetes, and cigarette smoking. Arterial hypertension causes myocardial hypertrophy and fibrosis, and affects coronary microcirculation by structural and functional changes of the small intramural resistance arteries, rarefiction of arterioles and capillaries and a distinct disturbance of endothelial vasomotion (i.e. "hypertensive remodeling"). Moreover, the presence of arterial hypertension predisposes to atherosclerotic coronary artery disease. Regarding the benefit-risk-ratio of antihypertensive therapy, benefit is much greater than risk: 1) An antihypertensive treatment with ACE-inhibitors, calcium channel blockers, beta-receptorblockers and anti-sympathicotonic substances leads to both reversal of LV hypertrophy and improvement of coronary flow reserve. Incidence of hypertensive heart failure has dropped considerably during the last 20 years. 3) Intervention studies have shown at least a clear tendency of a reduction in coronary morbidity and mortality. 4) In patients with coronary artery disease diastolic blood pressure should not be lowered under 85 mm Hg (J-curve). 5) An antihypertensive treatment should not adversely influence blood lipids when cholesterol is elevated. 6) Even in very elderly patients medical intervention to lower blood pressure is indicated from the cardiologic point of view (SHEP- and SHOP-studies).