Risks of untreated hypertension. A discussion.

There is a strong and graded association between blood pressure and the incidence of major coronary heart disease manifestations, congestive heart failure, stroke, and total mortality. The risk of any of these manifestations is also modified by other risk factors. Tobacco smoking affects the risk for all of the previously mentioned end points. Generally, lipid disturbances are only important predictors of coronary heart disease and total mortality. Several facts indicate that elevated blood pressure is causally related to the end points. There are, however, positive relations between blood pressure levels and heart rate, serum cholesterol level, body mass index, and, according to some studies, glucose intolerance. Some more basic abnormality may be responsible for the blood pressure increase and the increases in these other factors. Hypothetically, this abnormality may be more fundamentally related to some of the end points than is hypertension itself. If that is the case, then the type of antihypertensive treatment may be of decisive importance. Different end points may be affected differently by antihypertensive drugs, a factor that may be essential in the choice of drug treatment. Proper management of other risk factors is also essential in the prevention of cardiovascular disease.