Is cardioprotection important in the treatment of hypertension? Considerations for the ideal agent

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Background: The results of many studies designed to assess the effect of antihypertensive treatment have been, at first sight, disappointing with regard to expectations of a reduction in mortality due to coronary events. However, meta-analysis shows that there is a significant benefit, which is about two-thirds of that expected from the epidemiological data.Effects of thiazide diuretics: Older antihypertensive agents like thiazide diuretics have been shown to confer a degree of cardioprotection, although the mechanism of this effect is still unknown. Since these drugs have adverse effects on lipid and glucose metabolism, they are not (in theory) ideal agents, especially in younger patients. However, recent evidence suggests that these adverse effects may have been overemphasized.Effects of newer antihypertensive agents: Newer agents, such as angiotensin converting enzyme inhibitors and vasodilating β-blockers, may have experimental and theoretical advantages over older agents but there are insufficient mortality data to allow firm conclusions.Conclusions: While it is clear that hypertension is a risk factor for cardiovascular mortality, the effect of specific antihypertensive treatments on coronary heart disease mortality is still unresolved. There is a critical need for data on mortality, comparing the newer agents with thiazide diuretics, now increasingly well proven.

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