Is cardioprotection important in the treatment of hypertension? Considerations for the ideal agent.
BACKGROUND
The results of many studies designed to assess the effect of antihypertensive treatment have been, at first sight, disappointing with regard to expectations of a reduction in mortality due to coronary events. However, meta-analysis shows that there is a significant benefit, which is about two-thirds of that expected from the epidemiological data.
Older antihypertensive agents like thiazide diuretics have been shown to confer a degree of cardioprotection, although the mechanism of this effect is still unknown. Since these drugs have adverse effects on lipid and glucose metabolism, they are not (in theory) ideal agents, especially in younger patients. However, recent evidence suggests that these adverse effects may have been overemphasized.
Newer agents, such as angiotensin converting enzyme inhibitors and vasodilating beta-blockers, may have experimental and theoretical advantages over older agents but there are insufficient mortality data to allow firm conclusions.


CONCLUSIONS
While it is clear that hypertension is a risk factor for cardiovascular mortality, the effect of specific antihypertensive treatments on coronary heart disease mortality is still unresolved. There is a critical need for data on mortality, comparing the newer agents with thiazide diuretics, now increasingly well proven.
University of Oxford, John Radcliffe Hospital, UK.
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Sleight
D000818:Animals; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006321:Heart / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood
D000959:Antihypertensive Agents; D008055:Lipids