Implications of the primary prevention trials against coronary heart disease.
The bulk of the mortality (60%) in hypertension occurs in those with mild to moderate elevations of blood pressure, and the chief hazard is coronary disease. Although progression in the severity of hypertension has been slowed with drug therapy, the benefits for coronary outcome and all-cause mortality have been equivocal. Only a 10% reduction in coronary heart disease morbidity and mortality has been shown, an improvement that is not only small, but is statistically insignificant. Only vascular events such as renal failure, stroke, aortic dissection and cardiac failure have been reduced by antihypertensive therapy. Recent trials comparing beta-blockers with other antihypertensive drugs have failed to show the expected promise based on their effectiveness following a myocardial infarction. However, two large trials suggest that they may be effective against coronary heart disease in male non-smokers. A number of possible reasons for this therapeutic failure to reduce coronary heart disease have been postulated. The trials may have been too short to significantly affect the atherosclerotic progression. Also, sample sizes were too small to detect a sizeable reduction in coronary heart disease events. Furthermore, no attention was paid to improvements in the coronary heart disease risk profile, since drugs currently in use are known to have adverse effects on blood lipids, glucose tolerance and uric acid. It is even possible that a predisposition to sudden death is associated with antihypertensive therapy. The trials suggest that in attempts to prevent coronary heart disease, control of smoking and of serum lipids are particularly important in hypertensive persons and may be more effective than controlling the blood pressure alone.(ABSTRACT TRUNCATED AT 250 WORDS)
Kannel
W B
WB
Section of Preventive Medicine and Epidemiology, Boston University, Massachusetts.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000453:epidemiology / Q000517:prevention & control*; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D015201:Meta-Analysis as Topic; D011322:Primary Prevention; D012307:Risk Factors; D000074606:Smoking Prevention
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D004232:Diuretics