HYPERTENSION THERAPY AND RISK OF CORONARY HEART-DISEASE - HOW DO ANTIHYPERTENSIVES AFFECT METABOLIC FACTORS

A recent meta-analysis of hypertension treatment trials demonstrated a marked reduction in the incidence of cerebrovascular disease, but a l ess pronounced reduction in coronary heart disease. Treatment consiste d mainly of diuretics and beta-blockers, and this paper discusses the possible influences of their metabolic side effects on coronary risk f actors compared with newer agents: angiotensin-converting enzyme (ACE) inhibitors, selective alpha(1)-adrenoceptor inhibitors and calcium ch annel blockers. Several studies are underway to compare the effect of these compounds with diuretics and beta-blockers with respect to long- term cardiovascular morbidity and mortality. Until the results of thes e studies are available, young patients (i.e. <60-65 years) at high ri sk of coronary heart disease, especially patients with the insulin res istance syndrome or diabetes mellitus, should in our opinion be treate d with ACE-inhibitors, selective alpha(1)-adrenoceptor inhibitors or c alcium channel blockers.