Recent epidemiologic studies have demonstrated that, despite similar blood pressure reduction, decreases in the incidence of coronary artery disease among hypertensive patients are disappointing compared with the much more impressive reductions in cerebrovascular disease achieved in these patients. These findings are probably related to the fact that hypertension is not simply a ‘disease of numbers’, but is, rather, a complex syndrome of cardiovascular risk factors, all of which are genetically linked and all of which contribute to the development of cardiovascular disease in these patients. Included in the hypertension syndrome are abnormalities of lipid profile, insulin resistance, obesity, changes in renal function, left ventricular hypertrophy and reduced arterial compliance. In many patients, these associated cardiovascular risk factors precede the development of high blood pressure by many years. The recognition of the hypertension syndrome has resulted in a change of approach towards hypertensive patients. Selection of drugs for the treatment of hypertensive patients should be made in such a way that effective blood pressure control is achieved but the drugs have, at the same time, a beneficial or, at very least a neutral, effect on associated risk factors. This change in the management of hypertension may result in a significant impact on the incidence of coronary artery disease among hypertensive patients.
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