BEYOND BLOOD-PRESSURE

The majority of deaths attributable to increased blood pressure are due to coronary heart disease (CHD) and, consequently, the prevention of CHD should be the primary aim of hypertension management. It is clearly established that CHD has a multifactorial aetiology. As such, optimal hypertension management should include evaluation and management of all concomitant risk factors found in hypertensives. Data have shown that the newer agents such as ACE inhibitors, calcium antagonists and alpha-blockers have favourable effects on serum lipids, glucose intolerance, hyperinsulinaemia and left ventricular hypertrophy and, as such, are more likely to provide protection against coronary morbidity and mortality than diuretics and beta-blockers. While we do not have any long-term morbidity and mortality trial evidence to confirm or refute the potential benefits of these newer agents, such data are likely to be available in several years' time. In the meantime the practising physician has to make a best estimate as to what may be optimal therapy for hypertensive patients.