Antihypertensive therapy to maximally reduce coronary risk

Norman M Kaplan

doi:10.1016/0002-8703(93)90445-F

Antihypertensive therapy to maximally reduce coronary risk

Norman M Kaplan

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Abstract

Antihypertensive therapy as it is currently prescribed has not provided the degree of protection against coronary disease that was predicted by epidemiologic evidence. At least five steps can be taken to maximally reduce coronary risk: (1) more frequent, out-of-the-office monitoring of blood pressure, particularly during the early morning hours; (2) diligent search for other coexisting coronary risk factors; (3) vigorous use of various life-style modifications; (4) greater selectivity in the choice of antihypertensive agents, using those that may provide additional benefits for other coronary risk factors and other coexisting conditions; and (5) avoidance of coronary hypoperfusion by too great a reduction of blood pressure.

Original language	English (US)
Pages (from-to)	1487-1493
Number of pages	7
Journal	American heart journal
Volume	125
Issue number	5 PART 2
DOIs	https://doi.org/10.1016/0002-8703(93)90445-F
State	Published - May 1993

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/0002-8703(93)90445-F

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title = "Antihypertensive therapy to maximally reduce coronary risk",

abstract = "Antihypertensive therapy as it is currently prescribed has not provided the degree of protection against coronary disease that was predicted by epidemiologic evidence. At least five steps can be taken to maximally reduce coronary risk: (1) more frequent, out-of-the-office monitoring of blood pressure, particularly during the early morning hours; (2) diligent search for other coexisting coronary risk factors; (3) vigorous use of various life-style modifications; (4) greater selectivity in the choice of antihypertensive agents, using those that may provide additional benefits for other coronary risk factors and other coexisting conditions; and (5) avoidance of coronary hypoperfusion by too great a reduction of blood pressure.",

author = "Kaplan, {Norman M}",

note = "Funding Information: REFERENCES 1. Management Committee. Treatment of mild hypertension in the elderly. Med J Aust 1981;2:398-402. 2. Amery A, Birkenhager WH, Brixko P, Bulpitt C, Clement DL, Deruyttere M, et al. Mortalitv and morbidity results from the European working party on high blood pressure in the elderly trial. Lancet 1985;1:1349-54. t Coope J, Warrender TS. Randomised trial of treatment of hy-pertension in elderly patients in primary care. Br Med .I 1986;293:1145-51. 4. SHEP Cooperative Research Group. Prevemion of stroke by antihypertensive drug treatment in older persons with iso-lated svstolic hvnertension. JAMA 1991:265:32X-64. 5. DahlofB: Lindgolm LH, Hanson L, Schersten B, Ekbom {\textquoteleft}I{\textquoteright}, Wester P-O. Morbidity and mortality in the Swedish trial in old patients with hypertension (STOP-Hypertension). Lancet 1991;338:1281-5. 6. Medical Research Council Working Party. MRC trial of treat,-ment of hypertension in older adults: principal results. Br Med J 1992;304:405-12. I. Cutler JA, MacMahon SW, Furberg CD. Controlled clinical trials of drug treatment for hypertension: a review. Hyperten-sion 1989;13(suppl 1):1-36-I-44. 8. Kaplan NM. Treatment of hypertension: rationale and goals. In: Kaplan NM, ed. Clinical hypertension 5th ed. Baltimore: Williams & Wilkins, 1990:136. 9. Straznicky NE, Howes LG, Krum H, O{\textquoteright}Callaghan CJ, McNeil JJ, Phillips PA, Jackson B, Anavekar SN, Jandeleit K, Hur-ley JC, Louis ES, Louis WJ. Cardiac risk factor management: experience of an outpatient hypertension clinic. Med .J Aust 1991;155:691-700. 10. Willich SN, Goldberg RJ, Maclure M, Perriello L, Muller JE. Increased onset of sudden cardiac death in the first three hours after awakening. Am J Cardiol 1992;70:65-8. 11. Siegel D, Cheitlin MD, Seeley DG, Black DM, Hulley SB. Si-lent myocardial ischemia in men with systemic hypertension and without clinical evidence of coronary artery disease. Am J Cardiol 1992;70:86-90. 12. Zehender M, Meinertz T, Hohnloser S, Geibel A, Gerisch U, Olschewski M, Just H. Prevalence of circadian variations and spontaneous variability of cardiac disorders and ECG changes suggestive of myocardial ischemia in systemic arterial hyper-tension. Circulation 1992;85:1808-16. 13. Deedwania PC, Nelson JR. Pathophysiology of silent myocar-dial ischemia during daily life: hemodynamic evaluation by simultaneous electrocardiographic and blood pressure moni-torina. Circulation 1990:82:1296-304. 14. Neutel JM, Schnaper H,Cheung DG, Graettinger WF, Weber MA. Antihypertensive effects of P-blockers administered once daily: Twenty-four hour measurements. A~v HEART J 1990: 120:166-71. 15. Khoury AF, Sunderajan P, Kaplan NM. The early morning rise in blood pressure is related mainly to ambulation. Am J Hypertens 1992;5:339-44. 16. Anonymous. Blood-pressure monitors. Consumer Reports 1992;May:295-9. 17. Rosengren A, Wilhelmsen L, Wedel H. Coronary heart disease, cancer and mortality in male middle-aged light smokers. J ln-tern Med 1992;231:357-62. 18. Frank E, Winkleby MA, Altman DG, Rockhill B, Fortmann SP. Predictors of physicians{\textquoteright} smoking cessation advice. JAMA 1991;266:3139-44. Flavahan NA. Atherosclerosis or lipoprotein-induced",

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doi = "10.1016/0002-8703(93)90445-F",

language = "English (US)",

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journal = "American heart journal",

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T1 - Antihypertensive therapy to maximally reduce coronary risk

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N1 - Funding Information: REFERENCES 1. Management Committee. Treatment of mild hypertension in the elderly. Med J Aust 1981;2:398-402. 2. Amery A, Birkenhager WH, Brixko P, Bulpitt C, Clement DL, Deruyttere M, et al. Mortalitv and morbidity results from the European working party on high blood pressure in the elderly trial. Lancet 1985;1:1349-54. t Coope J, Warrender TS. Randomised trial of treatment of hy-pertension in elderly patients in primary care. Br Med .I 1986;293:1145-51. 4. SHEP Cooperative Research Group. Prevemion of stroke by antihypertensive drug treatment in older persons with iso-lated svstolic hvnertension. JAMA 1991:265:32X-64. 5. DahlofB: Lindgolm LH, Hanson L, Schersten B, Ekbom ‘I’, Wester P-O. Morbidity and mortality in the Swedish trial in old patients with hypertension (STOP-Hypertension). Lancet 1991;338:1281-5. 6. Medical Research Council Working Party. MRC trial of treat,-ment of hypertension in older adults: principal results. Br Med J 1992;304:405-12. I. Cutler JA, MacMahon SW, Furberg CD. Controlled clinical trials of drug treatment for hypertension: a review. Hyperten-sion 1989;13(suppl 1):1-36-I-44. 8. Kaplan NM. Treatment of hypertension: rationale and goals. In: Kaplan NM, ed. Clinical hypertension 5th ed. Baltimore: Williams & Wilkins, 1990:136. 9. Straznicky NE, Howes LG, Krum H, O’Callaghan CJ, McNeil JJ, Phillips PA, Jackson B, Anavekar SN, Jandeleit K, Hur-ley JC, Louis ES, Louis WJ. Cardiac risk factor management: experience of an outpatient hypertension clinic. Med .J Aust 1991;155:691-700. 10. Willich SN, Goldberg RJ, Maclure M, Perriello L, Muller JE. Increased onset of sudden cardiac death in the first three hours after awakening. Am J Cardiol 1992;70:65-8. 11. Siegel D, Cheitlin MD, Seeley DG, Black DM, Hulley SB. Si-lent myocardial ischemia in men with systemic hypertension and without clinical evidence of coronary artery disease. Am J Cardiol 1992;70:86-90. 12. Zehender M, Meinertz T, Hohnloser S, Geibel A, Gerisch U, Olschewski M, Just H. Prevalence of circadian variations and spontaneous variability of cardiac disorders and ECG changes suggestive of myocardial ischemia in systemic arterial hyper-tension. Circulation 1992;85:1808-16. 13. Deedwania PC, Nelson JR. Pathophysiology of silent myocar-dial ischemia during daily life: hemodynamic evaluation by simultaneous electrocardiographic and blood pressure moni-torina. Circulation 1990:82:1296-304. 14. Neutel JM, Schnaper H,Cheung DG, Graettinger WF, Weber MA. Antihypertensive effects of P-blockers administered once daily: Twenty-four hour measurements. A~v HEART J 1990: 120:166-71. 15. Khoury AF, Sunderajan P, Kaplan NM. The early morning rise in blood pressure is related mainly to ambulation. Am J Hypertens 1992;5:339-44. 16. Anonymous. Blood-pressure monitors. Consumer Reports 1992;May:295-9. 17. Rosengren A, Wilhelmsen L, Wedel H. Coronary heart disease, cancer and mortality in male middle-aged light smokers. J ln-tern Med 1992;231:357-62. 18. Frank E, Winkleby MA, Altman DG, Rockhill B, Fortmann SP. Predictors of physicians’ smoking cessation advice. JAMA 1991;266:3139-44. Flavahan NA. Atherosclerosis or lipoprotein-induced

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N2 - Antihypertensive therapy as it is currently prescribed has not provided the degree of protection against coronary disease that was predicted by epidemiologic evidence. At least five steps can be taken to maximally reduce coronary risk: (1) more frequent, out-of-the-office monitoring of blood pressure, particularly during the early morning hours; (2) diligent search for other coexisting coronary risk factors; (3) vigorous use of various life-style modifications; (4) greater selectivity in the choice of antihypertensive agents, using those that may provide additional benefits for other coronary risk factors and other coexisting conditions; and (5) avoidance of coronary hypoperfusion by too great a reduction of blood pressure.

AB - Antihypertensive therapy as it is currently prescribed has not provided the degree of protection against coronary disease that was predicted by epidemiologic evidence. At least five steps can be taken to maximally reduce coronary risk: (1) more frequent, out-of-the-office monitoring of blood pressure, particularly during the early morning hours; (2) diligent search for other coexisting coronary risk factors; (3) vigorous use of various life-style modifications; (4) greater selectivity in the choice of antihypertensive agents, using those that may provide additional benefits for other coronary risk factors and other coexisting conditions; and (5) avoidance of coronary hypoperfusion by too great a reduction of blood pressure.

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Antihypertensive therapy to maximally reduce coronary risk

Abstract

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