Cardiovascular risk factors and their interactions in hypertensives.

Numerous intervention trials have demonstrated clear benefits when patients with hypertension have been treated with antihypertensive drugs. During the last five years, however, community-based studies from Dalby, Gothenburg and Glasgow have reported a high remaining risk of cardiovascular (especially cardiac) disease, even though the hypertensive patients have been well cared for and their blood pressure controlled. There may be several possible explanations for the high remaining risk. First, long-standing hypertension may have caused irreversible cardiovascular change and atherosclerosis, which contribute to the increased risk even when the elevated arterial blood pressure has been reduced to normotensive levels. Another possible explanation is that the antihypertensive drugs themselves, in addition to their desired and beneficial antihypertensive effect, have some adverse effects. Thus, by elevating serum lipoproteins or by lowering serum potassium, some agents could increase the risk of cardiovascular complications and, to a certain extent, offset the beneficial effects of lowering blood pressure. Different drugs may, of course, also differ in their ability to prevent cardiovascular disease. In the studies mentioned above, blood pressure had not been reduced to strictly normotensive levels. This may be a third reason for the high remaining risks. A fourth possibility is that other metabolic factors may be implicated, and it may be necessary to tackle other, non-biological factors, such as smoking, stress and unemployment, in order to reduce the excess risk in hypertensive patients. It is clearly necessary to focus on the overall risk profile of the patient, including smoking and alcohol habits, cholesterol level, diet, weight, etc., rather than the blood pressure level alone.(ABSTRACT TRUNCATED AT 250 WORDS)