Diuretics, adrenergic inhibitors, and vasodilators-the three major classes of drugs used in the treatment of hypertension-have an impact on coronary heart disease. All three types of treatment reduce blood pressure to about the same degree, but with considerable individual variability with respect to their impact (positive or negative) on coronary heart disease risk. Hypokalemia, increased cholesterol levels, and hyperglycemia are common side effects of diuretic therapy that may exert a negative impact on coronary heart disease risk. Of the adrenergic inhibitors, the central agonists reverse left ventricular hypertrophy, whereas the alpha blockers generally have no adverse effect on cholesterol levels and may block coronary alpha receptors, both of which would have a positive impact on coronary risk. Beta blockers, the other class of adrenergic inhibitors, produce effects that can both negatively impact (lower high-density lipoprotein cholesterol levels and increase triglyceride levels) and positively impact (prevent arrhythmias and reverse left ventricular hypertrophy) coronary heart disease risk. The various types of vasodilators affect coronary risk differently: direct vasodilators stimulate sympathetics (negative impact), and converting enzyme inhibitors reverse left ventricular hypertrophy (positive impact). The effects of diuretics, adrenergic inhibitors, and vasodilators on all of these parameters need to be considered in the choice of therapy, particularly for the majority of asymptomatic patients with mild hypertension who are at relatively low risk for coronary heart disease.
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