Hypertension the Underappreciated Risks for Cardiovascular Disease

(Article By Linda Brookes Good, MSc courtesy medscape.com) Cardiovascular disease continues to be the number 1 cause of preventable death in the industrialized world.

That this is preventable is underlined by 2 recent reports. The first quantified how much the presence of just 3 cardiovascular risk factors shortened lifespan in almost 5000 patients followed up in the United Kingdom’s Whitehall Study, which began in the 1960s. A second study, from China, found that an extraordinary percentage of Chinese deaths can ultimately be traced to hypertension — and provokes criticism that the leading funding sources (for example, the World Health Organization, the World Bank, and the Bill & Melinda Gates Foundation) are mistaken in their emphasis on infectious disease.

Four studies on treatment options report some important advances. First, US national guidelines recommend a diuretic as a first-line choice for antihypertensive therapy, but what happens when the diuretic is added later? Second, further analysis of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) data investigated whether a second effect of beta-blockade — retardation of heart rate — might be beneficial in hypertensive patients compared with the effects of amlodipine.

Third, the United States has approved a single-pill, dual fixed-dose combination of an angiotensin receptor blocker (ARB) and the direct renin inhibitor, aliskiren — plus a new renin inhibitor with a “simple synthetic structure” goes into clinical trials. Fourth, a catheter-based renal denervation procedure may offer an alternative for treating resistant hypertension.

Finally, yet another report, this time from the Physicians Health Study of US male physicians, endorses the benefits of “moderate” alcohol consumption. In this report, alcohol lowered not just the risk for myocardial infarction (MI), but also the risk for all coronary heart disease, including angina pectoris, coronary bypass surgery, and percutaneous coronary intervention.

Hypertension Plus Hypercholesterolemia and Smoking Shorten Life Expectancy by 10 Years in Middle Age
A UK study in middle-aged men that began in 1967 has shown that the presence of 3 cardiovascular risk factors — high blood pressure, high cholesterol, and smoking — is associated with an almost 10-year shorter life expectancy compared with men with none of these risk factors.

The men also had a 3-fold higher rate of vascular mortality and a 2-fold higher rate of nonvascular mortality. These calculations were based on long-term follow-up data from the Whitehall study, which first examined 19,019 men aged 40-69 years between 1967 and 1970. At entry, 42% of the men were current smokers, 39% had high blood pressure, and 51% had high cholesterol.

The study, funded by the British Heart Foundation and the UK Medical Research Council; Robert Clarke, MD; and Jonathan Emberson, PhD (University of Oxford) and colleagues in London, analyzed data from 4811 men who participated in both the initial Whitehall examination and the follow-up in 1997. In this cohort, the mean blood pressure difference between those classed as having low blood pressure (systolic blood pressure [SBP] < 140 mm Hg) and high blood pressure (SBP ≥ 140 mm Hg) declined by two thirds between the 2 examinations (30.6 mm Hg difference in 1967 vs 8.3 mm Hg difference in 1997).

A similar pattern was seen for individuals with low and high levels of cholesterol (≥ 5 mmol/L vs < 5 mmol/L), with a mean difference of 1.86 mmol/L in 1967 vs 0.49 mmol/L in 1997.

Having high vs low blood pressure at baseline was associated with a hazard ratio of 1.64 for vascular mortality and 1.09 for nonvascular mortality, and a 3.5-year shorter life expectancy at age 50. The difference in life expectancy for men with the lowest and highest fifths of SBP was 5.2 years. High cholesterol was associated with a hazard ratio of 1.24 (1.18-1.30) for vascular mortality, and a 1-year shorter life expectancy compared with those with low cholesterol. Current smoking at study entry was associated with hazard ratios of 1.57 for vascular mortality and 2.07 for nonvascular mortality and an average 6.3-year difference in life expectancy compared with never-smoking.

Compared with men without any of these risk factors, the presence of all 3 risk factors at study entry was associated with a 10-year shorter life expectancy from age 50 (23.7 vs 33.3 years). Calculation of a risk score based on 4 categories of smoking and continuous measures of blood pressure and cholesterol concentration, plus glucose intolerance, employment grade, and body mass index, was associated with a 15.2-year difference (20.2 vs 35.4 years) when the highest and lowest 5% were compared.

These results “provide support for the public health policies aimed at achieving modest changes in major risk factors throughout the population to achieve improvements in life expectancy,” the researchers state. “Continued public health strategies to lower mean levels of the 3 main cardiovascular risk factors, together with more intensive medical treatment for ‘high risk’ subgroups . . . could result in further improvements in life expectancy,” they suggest.

Orignally posted at https://www.medscape.com/viewarticle/714604