Does hypertension confer a hypercoagulable state?

Although the blood vessels are exposed to high pressures in hypertension, the main complications of hypertension (stroke and myocardial infarction) are paradoxically thrombotic rather than haemorrhagic. In keeping with Virchow's triad, patients with hypertension do demonstrate abnormalities of vessel wall (endothelial dysfunction or damage), blood constituents (abnormal levels of haemostatic factors, platelet activation and fibrinolysis) and blood flow (rheology and flow reserve), suggesting that hypertension does confer a prothrombotic or hypercoagulable state. These abnormalities appear to be related to target organ damage and long-term prognosis and are altered by treatment. The observation that satisfactory blood pressure reduction with non-drug intervention and with various classes of antihypertensive drugs does not lead to an equal reduction in heart attacks and strokes may be due in part to unfavourable effects on the hypercoagulable state in hypertension. Antihypertensive agents with particular benefits in reducing this hypercoagulable state would be likely to have additional advantages in reducing the occurrence of stroke and other thromboembolic events.