Beyond blood pressure control. Effect of antihypertensive therapy on cardiovascular risk factors.

Mild hypertension accounts for approximately 60% of the mortality associated with high blood pressure. In addition to hypertension, other major cardiovascular risk factors include left ventricular hypertrophy (LVH), dyslipoproteinemia, and glucose intolerance. Thus, the effects of agents used to treat hypertension on these risk factors are of considerable importance. Large therapeutic intervention trials have shown that while adequate treatment of mild hypertension significantly and consistently reduces all-cause mortality as well as the risk of stroke and congestive heart failure, an anticipated reduction in coronary heart disease (CHD) has not been demonstrated. It is possible adverse metabolic side effects (hypercholesterolemia, hyperglycemia, hypokalemia) of widely used agents, such as diuretics and beta-blockers may be partially offsetting the beneficial effects of blood pressure reduction, with the net result being a failure of these agents to reduce the risk of CHD. Angiotensin-converting enzyme inhibitors (ACEIs) and calcium channel blockers do not produce these adverse metabolic derangements. The use of antihypertensive agents that have favorable or neutral metabolic effects should further reduce the risk of cardiovascular morbidity and mortality attributable to high blood pressure, including CHD.