DETECTION OF PRECLINICAL ATHEROSCLEROSIS MAY OPTIMIZE THE MANAGEMENT OF HYPERTENSION

Because of the limited ability of blood pressure elevation to predict risk, the mass drug treatment of hypertension above an arbitrary thres hold may result in many subjects being overtreated. One potential way to overcome this problem is to noninvasively detect preclinical athero sclerosis. Hypertension has been shown to be associated with I) increa sed intima-media thickness and more frequent plaques in extracoronary arteries, 2) more frequent calcifications in coronary arteries, 3) inc reased wall rigidity in the aorta and peripheral arteries, and 4) impa ired endothelium dependent vasodilation and abnormal blood rheology, w hich are capable of promoting the conversion of atherosclerosis into a therothrombosis. The prognostic significance of these markers of precl inical atherosclerosis is supported by evidence of their association w ith numerous risk factors, and prevalence and incidence of cardiovascu lar damages. Preclinical arterial lesions also constitute ideal target s to test whether antihypertensive treatment can reverse or slow down arterial disease, and whether such a reversal produces better preventi on than simply lowering blood pressure. Finally, the detection of athe rosclerosis applied to large populations of mildly hypertensive subjec ts safely and at relatively low cost could help to better target the p harmacological treatment, given that a substantial proportion of subje cts without evidence of preclinical disease may be suitable for nondru g treatment. (C) 1997 American Journal of Hypertension, Ltd.