Cardiovascular effects of antihypertensive drugs--involvement in the therapeutic choice.
Hypertensive patients are at an increased risk of developing cerebrovascular and cardiovascular disease. Treatment has resulted in a substantial reduction in cerebrovascular deaths but not in cardiovascular mortality. As the number of deaths from myocardial infarction exceeds the sum of all other hypertension-related mortalities, these results are disappointing. The hypothesis that metabolic side effects of many antihypertensive drugs offset the potential benefit of decreasing blood pressure is of particular interest. In established hypertension there is an increase in total peripheral resistance. Long-term therapy with diuretics decreases vascular resistance. This is also evident with dihydropyridine calcium antagonists, vasodilators, angiotensin-converting enzyme inhibitors and alpha blockers. In patients with hypertension, an increased wall to lumen ratio occurs in resistance vessels where mechanisms such as smooth muscle hypertrophy and increased amounts of elastin and collagen are present. In small resistance vessels, long-term antihypertensive therapy has a positive effect, but the effect in large arteries is variable.
Hypertension Unit, Hospital Universitario San Carlos, Complutense University, Madrid, Spain.
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M
Luque-Otero
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Fernandez-Pinilla
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006331:Heart Diseases / Q000517:prevention & control*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D014652:Vascular Diseases / Q000517:prevention & control
D000959:Antihypertensive Agents