ArticleIs it the blood pressure or the blood vessel?
Section snippets
Risk Factors and Blood Pressure
Hypertension, as traditionally defined, is often accompanied by other risk factors for cardiovascular disease.10 Indeed, the presence of these risk factors, including elevated blood cholesterol, smoking, diabetes, and obesity, greatly increases the risk for hypertension-related morbid events.11 The prevalence of these risk factors in hypertensive patients often generates concerns about co-inheritance or common environmental factors. But one physiological mechanism seems clear. These risk
Mechanisms of Drug Effects
Vasodilation usually is accompanied by a reduction in diastolic and mean arterial pressure. Dilation of the microvasculature that controls vascular resistance may be a direct smooth muscle effect of a drug, may be a consequence of interference with an endogenous vasoconstrictor mechanism, or may result from local generation of a vasodilator such as nitric oxide. Although the initial fall in blood pressure induced by any of these mechanisms may be comparable, the long-term efficacy of such drugs
Cardiovascular Morbid Events
Hypertension contributes to a wide range of cardiovascular morbidity, including angina pectoris, myocardial infarction, stroke, heart failure, renal failure, peripheral vascular disease, dementia, and sudden death. Most of these events are a consequence of progressive structural change in the vasculature sometimes interrupted by a thrombotic event. These structural changes are often classified as atherosclerosis, but the mechanisms of these adverse events vary. Some are predominantly
Relationship Between Blood Pressure and Cardiovascular Disease
The apparent linear relationship between casual blood pressure in a population and risk of a cardiovascular morbid event has led some to the simple conclusion that blood pressure is the lethal risk factor.33 Although pressure itself exerts effects on the artery wall and the left ventricle that may contribute to morbidity, it is difficult to attribute to pressure itself the vascular events that occur in so-called pre-hypertensives with casual pressures below 130/85 mm Hg. Indeed, no guideline is
Effect of Drugs on Blood Pressure and Cardiovascular Events
There is now substantial trial evidence that antihypertensive drugs reduce the incidence of morbid events and prolong life in hypertensive patients. In the early trials that were placebo-controlled, baseline blood pressures were usually >160/100 mm Hg, likely indicative of co-existent structural abnormalities of the vasculature, and other risk factors were not treated.35, 36, 37, 38 The magnitude of therapeutic benefit in those populations cannot simply be extrapolated to contemporary cohorts
Specific Drug Effects
As noted in the preceding text, drugs exert their antihypertensive effects by a variety of mechanisms. When pressure is markedly elevated, the benefit of pressure reduction itself may overwhelm mechanistic differences in the prevention from cardiovascular disease events. When pressures are only modestly increased or within the so-called normal range, the mechanistic difference may become particularly important. Therapeutic benefit on the artery wall will, however, produce long-term reduction of
Prevention of Hypertension
The emphasis in cardiovascular health care in the next generation should shift from end-stage disease management to early detection and treatment to slow progression. Prevention of hypertension has, therefore, become a clinical goal.69 But the concept of prevention of hypertension suffers from the same semantic deficiency as the concept of pre-hypertension.34 Some, but not all, individuals with blood pressure <140/90 mm Hg harbor endothelial dysfunction likely to progress to structural
Clinical Implications
Resting blood pressure, despite its variability, should continue to serve as a useful and simple screening tool to stratify patients into risk categories. It must be recognized, however, that these risk categories based on blood pressure alone do not necessarily mandate therapeutic decisions for individual patients. Identifying vascular functional and structural abnormalities may in the future determine the need or lack of need for therapeutic interventions. One approach to this effort is
References (72)
- et al.
Relation of hemodynamic load to left ventricular hypertrophy and performance in hypertension
Am J Cardiol
(1983) Left ventricular hypertrophy and angiotensin II antagonists
Am J Hypertens
(2001)- et al.
Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol
Lancet
(2002) - et al.
Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial
Lancet
(2005) - et al.
Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial
Lancet
(1998) - et al.
Influence of blood pressure on the effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine in the African-American Heart Failure Trial
J Am Coll Cardiol
(2007) - et al.
The prevention of coronary events and stroke with atorvastatin in hypertensive subjects with average or below average cholesterol levelsThe Anglo-Scandinavian Cardiac Outcomes Trial: Lipid Lowering Arm (ASCOT:LLA)
Lancet
(2003) - et al.
Effects of ramipril on left ventricular mass and function in cardiovascular patients with controlled blood pressure and with preserved left ventricular ejection fraction: a substudy of the Heart Outcomes Prevention Evaluation (HOPE) trial
J Am Coll Cardiol
(2004) - et al.
Valsartan benefits left ventricular structure and function in heart failure: Val-HeFT echocardiographic study
J Am Coll Cardiol
(2002) - et al.
Treatment with amlodipine and atorvastatin have additive effect in improvement of arterial compliance in hypertensive hyperlipidemic patients
Am J Hypertens
(2003)
Marked improvement in left ventricular ejection fraction during long-term beta-blockade in patients with chronic heart failure: clinical correlates and prognostic significance
Am Heart J
Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial
Lancet
Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial
Lancet
Screening for early detection of cardiovascular disease in asymptomatic individuals
Am Heart J
Arteries, myocardium, blood pressure, and cardiovascular risk: towards a revised definition of hypertension
J Hypertens
Expanding the definition and classification of hypertension
J Clin Hypertens
Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomized trials
Lancet
Angiotensin-converting enzyme inhibitors and calcium channel blockers for coronary heart disease and stroke prevention
Hypertension
Blood pressure reduction is not the only determinant of outcome
Circulation
It is not beyond the blood pressure; it is the blood pressure
Circulation
Remodeling of resistance vessel structure in essential hypertension
Curr Opin Nephrol Hypertens
Hemodynamic patterns of age-related changes in blood pressure: the Framingham Heart Study
Circulation
Haemodynamic effects of beta blockers
Drugs
Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart diseaseOverall findings and differences by age for 316,099 white men
Arch Intern Med
Blood pressure as a cardiovascular risk factor
JAMA
Nitric oxide activity in the human coronary circulationImpact of risk factors for coronary atherosclerosis
J Clin Invest
Tissue angiotensin and pathobiology of vascular disease: a unifying hypothesis
Hypertension
The role of the renin-angiotensin system in the development of cardiovascular disease
Am J Cardiol
Possible role of the vascular renin-angiotensin system in hypertension and vascular hypertrophy
Hypertension
Indirect evidence for the release of endothelium-derived relaxing factor in the human forearm circulation in vivo: blunted response in essential hypertension
Circulation
Role of endothelium-derived nitric oxide in the abnormal endothelium-dependent vascular relaxation of patients with essential hypertension
Circulation
Angiotensin and cell growth: a link to cardiovascular hypertrophy?
J Hypertens
Blood pressure-independent attenuation of cardiac hypertrophy by AT(1)R-AS gene therapy
Hypertension
Angiotensin inhibitors regressed cardiac hypertrophy and transforming growth factor-β 1 expression
Hypertension
Nitric oxide protects against pathological ventricular remodeling: reconsideration of the role of NO in the failing heart
Circ Res
Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults
N Engl J Med
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Cardiovascular Disease Progression: A Target for Therapy?
2018, American Journal of MedicineCitation Excerpt :The age-dependent progression of structural changes in the arteries and heart mandates that chronological age will be a powerful but nondiscriminating risk factor, whereas blood pressure serves not only as a statistical risk factor but as a marker for the vascular disease that thickens and stiffens the small and large arteries. An elevated blood pressure itself will also accelerate the pathological process in the artery wall.13 Smoking and diabetes are potent contributors to cardiovascular risk, whereas cholesterol levels, including their low-density lipoprotein and high-density lipoprotein fractions, have proven to be less discriminating.14
Flavonoids and cardiovascular diseases
2024, Advances in Flavonoids for Human Health and Prevention of DiseasesEnhanced vasorelaxation effect of endogenous anandamide on thoracic aorta in renal vascular hypertension rats
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Conflict of interest: none.