Antihypertensive therapy and lipids. Evidence, mechanisms, and implications.

Elevations in the levels of total serum cholesterol, triglycerides, and low-density lipoproteins increase the risk of coronary artery disease and atherogenesis. High-density lipoproteins (HDLs) are beneficial in removing lipid from tissues. High-risk men adhering to a diet and/or receiving cholestyramine to lower their elevated lipid levels had lowering of cardiac mortality. Hypertension is also a major risk factor for cardiovascular disease and for accelerated atherosclerosis. The benefit of blood pressure reduction may not be consistent in decreasing cardiovascular morbidity and mortality among all mildly hypertensive persons. Many antihypertensive agents may raise undesirable lipid fractions and/or lower HDL levels, enhancing the risk of cardiovascular disease, while others have few negative effects. Thus, the antihypertensive agent chosen may modify lipid levels and cardiovascular risk in hypertensive patients.