Why lowering blood pressure is not enough: the hypertension syndrome and the clinical context of cardiovascular risk reduction.
Although drug treatment for hypertension has been widely used for many years, overall control of this disease continues to be less than optimal. Hypertension treatment has had a positive impact on stroke rates, but rates of coronary heart disease remain high. One reason for this lack of success in treatment is that physicians have focused too narrowly on lowering blood pressure. Blood pressure is a critical element of hypertension, but many other interrelated risk factors contribute to form a complex syndrome of hypertension. Studies show that young adult subjects who do not yet have high blood pressure but do have a family history of hypertension exhibit increased incidence of other risk factors, such as high cholesterol, left ventricular dysfunction, reduced arterial compliance, and insulin resistance. These patients with "normotensive hypertension" share many characteristics with patients with fully developed hypertension, both uncontrolled and controlled. The link between these many risk factors and high blood pressure seems to lie in endothelial cell balance. If this balance is upset, elements of the hypertension syndrome start to become manifest, often before blood pressure becomes elevated. Angiotensin-converting enzyme inhibitors can restore this critical balance, improving overall arterial health and arterial compliance and thus preventing the progression of the hypertension syndrome to high blood pressure and, ultimately, target organ damage.
Neutel
J M
JM
Department of Clinical Pharmacology, Orange County Heart Institute, 505 S. Main Street #1025, Orange, CA 92868, USA. jmneutel@aol.com
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D012307:Risk Factors; D013577:Syndrome
D000806:Angiotensin-Converting Enzyme Inhibitors