Blood pressure control and cardiovascular risk reduction

Abstract

The ultimate goal of antihypertensive therapy is cardiovascular risk reduction. As lowering blood pressure per se reduces risk for myocardial infarction only by 20%-25%, it is obvious that a better protection is needed. An optimal strategy to reduce risk in hypertensives may include lifestyle modification, promotion of adherence to therapy, early and aggressive target levels achievement by appropriate drug choice. Clinical trial data suggest that RAAS blockers can reduce the risk at least partly independently of BP lowering. In addition, as hypertension is associated with a constellation of other risk factors, the global risk reduction is nowadays going to become the gold standard in therapy. The most common and important coexisting risk factor is hypercholesterolemia. This is not simply a co-existence but there is an independent and causal relationship between lipids and hypertension and there is a physiologic rationale and evidence for statins use especially in patients with complicated hypertension or in patients with more than two risk factors. So, whilst blood pressure lowering is undoubtedly beneficial, we have to focus on the global cardiovascular risk. We must go beyond blood pressure and the most effective way to go "beyond BP" is to add a statin.

Keywords: blood pressure; cardiovascular risk; statin.

Figure 1. Relative risk of mortality from any cause among subjects with various risk factors and exercise capacities (95% confidence intervals for the relative risks in parentheses).BMI: Body Mass Index, COPD: Chronic Obstructive Pulmonary Disease; modified from Myers and colleagues (8)

Figure 2. ASCOT-BPLA reduction in Cardiovascular Mortality