The Importance of Blood Lipid Levels in BP Control Effects of current antihypertensive therapy are not completely clear

During the 1970s, educational and therapeutic programmes resulted in the detection and treatment of many people with systemic hypotension. As a result of this, the incidence of stroke, dissection of the aorta and fatal coronary artery disease are thought to be decreasing.

Attention in the 1980s has turned to lowering the blood lipid levels. Hypercholesterolaemia is defined roughly as total plasma cholesterol > 220 mg/dl for individuals up to 30 years of age and > 240 mg/dl for those over 40 years. The results of educational programmes will not be evident for some time.

The Lipid Research Clinics Coronary Primary Prevention Trial which involved 3086 men showed that decreasing the total plasma cholesterol levels also caused a decrease in the frequency of fatal coronary artery disease, nonfatal myocardial infarction, the appearance of angina pectoris, congestive heart failure, resuscitated cardiac arrest, positive exercise stress test and coronary artery bypass grafting. Thus, the opposite can be inferred: that increased cholesterol levels will increase the risk of the above occurrences.

Long term antihypertensive therapy may alter both total cholesterol and low density lipoprotein (LDL) levels. Diuretic therapy results in an increase in total and LDL cholesterol levels during the first year followed by a decrease to normal or below. Up to 4 years later, no increase occurs. The effect of treatment with (3-blockers without intrinsic sympathomimetic activity is to increase and decrease the triglyceride and high-density lipoprotein-cholesterol levels, respectively, but the levels of LDL and total cholesterol are unaffected. (3-Blockers with intrinsic sympathomimetic activity have little effect on any of these parameters. Unfortunately, many studies have not established adequate baseline measurements, have not included randomisation or have involved more than 1 drug. Further work is required to determine the long-term effects of current antihypertensive therapy. Ideally, BP and blood lipid levels should be decreased simultaneously 'but lacking this Ideal antihypertensive 6gent at present, It is Important that blood pressure lowering Is not accompanied by blood lipid raising'. Roberts we. American Journal of Cardiology 57: 379-380, 1 Feb 1986

0156-2703/86/1005-0003/0$01.00/0 © ADIS Press INPHARMA® 15 Mar 1986 3