Cardiovascular risk factors and antihypertensive therapy.

Reduction of elevated blood pressure is effective in reducing morbidity and mortality from cardiovascular disease in general. Striking decreases in stroke, congestive heart failure, and renal impairment have been observed when blood pressure is reduced. However, the ability of traditional, diuretic-first, stepped-care therapeutic algorithms to reduce the occurrence of myocardial infarction or angina has been exceedingly difficult to demonstrate. An increased frequency of sudden death among hypertensive men with electrocardiographic abnormalities has been observed in some diuretic-based treatment trials. The failure of conventional therapy to reduce coronary artery disease and death has forced a re-appraisal of antihypertensive treatment. The risk factors for coronary disease are reviewed in detail with an emphasis on the impact of various classes of antihypertensive drugs on these factors. The emergence of effective antihypertensive agents that lower blood pressure without adversely affecting cardiovascular risk factors provides a new opportunity to further extend the benefit of treatment by reducing such risk.