Hypertension therapy and risk of coronary heart disease: how do antihypertensives affect metabolic factors?
A recent meta-analysis of hypertension treatment trials demonstrated a marked reduction in the incidence of cerebrovascular disease, but a less pronounced reduction in coronary heart disease. Treatment consisted mainly of diuretics and beta-blockers, and this paper discusses the possible influences of their metabolic side effects on coronary risk factors compared with newer agents: angiotensin-converting enzyme (ACE) inhibitors, selective alpha 1-adrenoceptor inhibitors and calcium channel blockers. Several studies are underway to compare the effect of these compounds with diuretics and beta-blockers with respect to long-term cardiovascular morbidity and mortality. Until the results of these studies are available, young patients (i.e. < 60-65 years) at high risk of coronary heart disease, especially patients with the insulin resistance syndrome or diabetes mellitus, should in our opinion be treated with ACE-inhibitors, selective alpha 1-adrenoceptor inhibitors or calcium channel blockers.
Moan
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Department of Internal Medicine, Ullevål Hospital, Oslo, Norway.
Os
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Hjermann
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Kjeldsen
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D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D003327:Coronary Disease / Q000209:etiology / Q000378:metabolism* / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D007333:Insulin Resistance; D012307:Risk Factors; D013577:Syndrome
D000959:Antihypertensive Agents