The future of pharmacological therapy for risk factor reduction. Hypertension.

Treatment of elevated arterial pressure has been shown to reduce hypertension-induced mortality and morbidity in severe as well as in milder forms of hypertension, but results are suboptimal, and treated hypertensive patients still have significantly higher cardiovascular morbidity and mortality than comparable normotensive subjects. In particular, the risk of coronary heart disease has been little affected by antihypertensive treatment. There may be several explanations for these less than ideal results of antihypertensive treatment; for example, that blood pressure has not been brought down to strictly normotensive levels or that several of the commonly used antihypertensive agents increase serum lipoprotein concentrations, which to a certain extent may offset the intended therapeutic effect. To improve results of antihypertensive treatment it appears desirable (1) to lower blood pressure to strictly normotensive levels, (2) to use antihypertensive agents, e.g. ACE inhibitors, which do not negatively affect serum lipoproteins, (3) to supplement antihypertensive therapy with active lipid-lowering therapies in selected patients. Such means should have a positive effect on reducing the risk of coronary heart disease.