Failure to reduce cholesterol as explanation for the limited efficacy of antihypertensive treatment in the reduction of coronary heart disease. Evidence from the Hypertension Detection and Follow-up program (1973-1979).

The recent experience of six large trials of antihypertensive therapy has not clearly demonstrated any beneficial effect on the prevention of coronary heart disease (CHD). The data from the HDFP study have been analyzed by three cholesterol strata at baseline. The higher the baseline cholesterol levels, the greater the risk for CHD. In hypertensive patients, the slope of the relationship between cholesterol and CHD event rate was examined. There is indication of an increase of about 6 CHD events per 1,000 patients for each 50 mg/mdl increase in cholesterol (p less than 0.05). This population was further divided into those with major end organ damage (EOD) and those without EOD at baseline. In patients who had no EOD, examination of baseline cholesterol level and 5-year CHD death rates indicates a similar relationship. In contrast, the lack of correlation between baseline cholesterol level and CHD death rates in those hypertensives with EOD, suggests the need to reduce hypercholesterolemia before EOD occurs.