Hypertensive patients have an excess of other cardiovascular risk fact
ors. Moreover, traditional therapy based on diuretics and beta-blocker
s may aggravate these risk factors. Therefore, attention must be given
to the identification of all pertinent risk factors and their amelior
ation by appropriate therapy. Such therapy must include lifestyle chan
ges including cessation of smoking, reduction of obesity, moderation o
f sodium intake and alcohol consumption, and increased physical activi
ty. When antihypertensive drugs are chosen, consideration should be gi
ven to their potential influences, either negative or positive, on oth
er cardiovascular risk factors. In particular, the adverse effects of
diuretics and beta-blockers on lipids and insulin sensitivity may prec
lude their use. alpha-Blockers and ACE inhibitors may have beneficial
effects on these metabolic indices. Calcium antagonists are neutral in
most regards. Whatever agents are chosen, the use of low doses in com
bination is being increasingly recognized as a better way to achieve t
he desired antihypertensive efficacy while minimizing adverse effects.
As has been noted in the other papers in this supplement, the combina
tion of an ACE inhibitor and a calcium antagonist is particularly attr
active, not only to treat hypertension, but also to ameliorate other c
ardiovascular risk factors. (C) 1997 American Journal of Hypertension,
Ltd.