HYPERTENSION AND CORONARY-ARTERY DISEASE - AN UNSOLVED PROBLEM

Drug treatment of hypertension reduced the incidence of stroke by 40% and prevented cardiac and renal failure, but had less effect on coronary artery disease in the major trials. Coronary events were reduced by about 14% (confidence limits of 4-22%), which compares to the reduction of 20-25% anticipated from epidemiological studies. Any shortfall in coronary prevention that could be attributable to adverse effects of antihypertensive drugs would therefore amount to only 6-11% of all coronary events, and could easily arise by chance. At present, there are no grounds for preferring one class of drug over another from the point of view of coronary prevention, or for altering the "target" diastolic pressure during treatment. Strategies other than blood pressure reduction aimed at preventing coronary disease in hypertensive subjects need to be explored. They should, however, be examined in large controlled outcome trials, and should not be introduced to ordinary practice on the basis of the inadequate evidence currently available.