Is Prevention of Ischemic Heart Disease Possible in Hypertensives?

Abstract

High blood pressure (BP) leads to myocardial hypertrophy, a process in which catecholamines, and probably other hormones, are involved. The increased BP also enhances coronary arteriosclerosis, and the combination of myocardial and coronary effects increases the risk of myocardial infarction and arrhythmias. The risk of ischemic heart disease (IHD) is also influenced by smoking and lipid disturbances, and the risk of IHD events increases already at moderate BP elevation. It is important that the antihypertensive treatment does not adversely affect the arteriosclerotic process, which is a major threat for hypertensive patients. Trials of anti-hypertensive treatment have all been of low power and relatively short duration and therefore have not provided a definite answer concerning a significant effect on IHD. Investigations are being performed to determine whether certain drugs are more advantageous than others in preventing IHD events. In addition to their hypotensive effects in hypertensive patients, beta-blocking drugs may prevent IHD in accordance with their preventive effects in patients who have suffered a myocardial infarction. Diuretics may, however, be hazardous because of their effects on electrolytes-notably potassium-thereby increasing the risk of arrhythmias.