[Non-hemodynamic vascular risk in the patient with arterial hypertension. The effects of medical therapy].

Systemic hypertension is associated with an increased risk of cerebrovascular and coronary events. The exact role of antihypertensive therapy in reversing or reducing the incremental risk is still a matter of debate. Stroke in hypertension can be large vessel disease (atherothrombotic ischemic stroke), or small vessel disease resulting in lacunar lesions or an intracerebral haemorrhage. In the major trials evaluating the benefits of antihypertensive therapy the entire excess risk of stroke (35 to 45%) can be reversed in 3-5 years. Data on coronary events are less clearcut but the most recent metanalyses including data from trials in elderly patients show that the reduction in coronary events is larger and more significant than in previous metanalyses (approximately 16%). ACE-inhibitors and calcium channel blockers have many potential advantages over diuretics and beta-blockers. Their role is under investigation in ongoing clinical trials.