[High blood pressure and coronary heart disease. Are there new therapeutic options?].
Besides type 2 diabetes and cigarette smoking arterial hypertension represents the most powerful risk factor for the development of coronary artery disease. Independent from the existence of coronary artery disease i. e. coronary macroangiopathy arterial hypertension leads to hypertension-specific organ manifestations such as left ventricular hypertrophy and coronary microangiopathy. In the presence of coronary artery disease left ventricular hypertrophy and coronary microangiopathy aggravate the ischemic predisposition of the myocardium. Thus vascular protection measures should represent an important component of antihypertensive treatment. Due to the present state of the art based upon randomized clinical studies ACE-inhibitors are first-line antihypertensive substances due to their vascular and myocardial protective effects and their few side effects. Angiotensin II receptor blockers are not more effective than ACE-inhibitors in treatment arterial hypertension so far. Calcium channel blockers who do not stimulate the sympathetic system such as slow release verapamil and amlodipin, beta receptor blockers and diuretics are combination partners, if blood pressure cannot be normalized by treatment with ACE-inhibitors only. Since statins reduce cardiovascular morbidity and mortality in hypertensive patients even with not elevated LDL cholesterol levels, statins represent an important component of antihypertensive treatment. An antihypertenive treatment aiming at reducing blood pressure only is no more sufficient due to the present state of the art.
Motz
Wolfgang
W
Herz- und Diabeteszentrum Mecklenburg-Vorpommern, Klinikum Karlsburg, Herz-Kreislaufforschung, Universität Witten/Herdecke, Witten/Herdecke. WMotz@t-online.de
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000145:classification* / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000628:therapy; D008297:Male; D010818:Practice Patterns, Physicians'
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors