Summary
Over the past 6 years, major hypertension intervention studies in Europe, Australia, and the USA have shown disappointing results in the prevention of coronary heart disease (CHD) in spite of adequate treatment and good compliance. Recently, it has become increasingly clear that hypertensives with or without treatment display higher cholesterol levels than normotensive persons. The present review examines cholesterol levels in six intervention studies, none of which offered dietary or drug therapy for hypercholesterolemic patients. The Oslo study and the British MRC Trial reported very high average cholesterol levels and both showed no protection from CHD through intensive therapy in comparison to control patients. The Australian and the American MRFIT studies produced evidence for reduced coronary mortality among hypertensives with low in contrast to those with high cholesterol levels. The European Working Party showed indirectly that patients with marked reduction in blood pressureand cholesteral had a significantly lower cardiac mortality compared to placebo-treated patients. The IPPPSH study found that increasing cholesterol levels in hypertensives under beta blockeror diuretic therapy increased the risk of myocardial infarction.
Failure to reduce cholesterol in hypertensive patients apparently is a major reason for the limited efficacy of antihypertensive treatment in the reduction of CHD.
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Abbreviations
- CHD:
-
Coronary heart disease
- HDFP:
-
Hypertension Detection and Follow-up Program
- IPPPSH:
-
International Prospective Primary Prevention Study in Hypertension
- MI:
-
Myocardial infarction
- MRC:
-
Medical Research Council
- MRFIT:
-
Multiple Risk Factor Intervention Trial
References
Amery A, Birkenhager W, Brixco P, Bulpitt C, Clement D, Deruyttere M, De Schaepdryver A, Dollery C, Fagard R, Forette F, Forte J, Hamdy R, Henry JF, Joossens JV, Leonetti G, Lund-Johansen P, O'Malley K, Petrie J, Strasser T, Tuomilehto J, Williams B (1985) Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial. Lancet I:1349–1354
Amery A, Birkenhager W, Bulpitt C, Clement D, Deruyttere M, De Schaepdryver A, Dollery C, Fagard R, Forette F, Forte J, Hamdy R, Leonetti G, Lund-Johansen P, Mac-Farlene JPR, Mutsers A, O'Malley K, Tuomilehto J (1982) Influence of antihypertensive therapy on serum cholesterol in elderly hypertensive patients. Acta Cardiolog 37:235–244
Breckenridge A (1985) Treating mild hypertension (Editorial). Br Med J 291:89–90
Comstock GW, Suzuki T, Stone RW, Crumrine JL, Johnson DH, Sakai Y, Matsuya T, Sasaki S (1985) Cardiovascular risk factors in American and Japanese executives. J Roy Soc Med 78:536–545
Consensus Conference (1985) Lowering blood cholesterol to prevent heart disease. JAMA 253:2080–2086
Helgeland A (1980) Treatment of mild hypertension: a five-year controlled drug trial. The Oslo Study. Am J Med 69:725–732
Hjermann I, Holme I, Leren P (1986) Oslo Study diet and antismoking trial. Results after 102 months. Am J Med 80 [Suppl 2A]:7–11
IPPPSH Collaborative Group (1985) Cardiovascular risk and risk factors in a randomized trial of treatment based on the beta-blocker Oxprenolol: the International Prospective Primary Prevention Study in Hypertension. J. Hypertens 3:379–392
Lipid Research Clinics Coronary Primary Prevention Trial (1984) Results. I. Reduction in incidence of coronary heart disease. II. The relationship of reduction in incidence of coronary heart diesease to the cholesterol lowering. JAMA 251:351–364; 365–374
MacMahon SW, MacDonald GJ, Blacket RB (1985) Plasma lipoprotein levels in treated and untreated hypertensive men and women. The National Heart Foundation of Australia Risk Factor Prevalence Study. Arteriosclerosis 5:391–396
MacMahon SW, McDonald GJ (1986) Antihypertensive treatment and plasma lipoprotein levels. Am J Med 80 [Suppl 2A]:40–47
Medical Research Council Working Party (1985) MRC trial on treatment of mild hypertension: principal results. Br Med J 291:97–104
Management Committee of the Australian National Blood Pressure Study (1984) Prognostic factors in the treatment of mild hypertension. Circulation 69:668–676
Multiple Risk Factor Intervention Trial Research Group (1982) The Multiple Risk Factor Intervention Trial (MRFIT). Risk factor changes and mortality results. JAMA 248:1465–1472
The Framingham Study (1968) An epidemiological investigation of cardiovascular disease. Section 28, U.S. Dept. of Health, Education and Welfare
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Heyden, S., Schneider, K.A. & Fodor, G.J. Failure to reduce cholesterol as explanation for the limited efficacy of antihypertensive treatment in the reduction of CHD. Klin Wochenschr 65, 828–832 (1987). https://doi.org/10.1007/BF01727479
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DOI: https://doi.org/10.1007/BF01727479