Differential effects of antihypertensive agents in experimental and human atherosclerosis.

The association between hypertension and atherosclerosis is complex, incorporating endothelial dysfunction, abnormalities of insulin and lipid metabolism, altered vascular biology, and impaired arterial compliance. Results of experimental and human studies suggest that there is heterogeneity in the manifestations of disease and responses to therapy among different animal species, vascular territories, and individual patients. Antihypertensive therapy requires the careful selection of specific agents that reduce blood pressure and preferentially and positively modulate the synergistic interaction of the many facets of disease, with the goal of preventing or regressing atherosclerosis. Angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, and alpha-blockers appear to hold the greatest promise in this regard.