THE CHALLENGE OF MANAGING MULTIPLE CARDIOVASCULAR RISK-FACTORS

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.