Familial Aspects of the Hypertension Syndrome

Recent epidemiologic studies have demonstrated that, despite similar blood pressure reduction, decreases in the incidence of coronary artery disease among hypertensive patients are disappointing compared with the much more impressive reductions in cercbrovascular disease achicved in thcsc patients. T h e s c findings are probably relatcd to the fact that hypcrtension is not siinply a 'disease of numbers', but is, rathcr, a complex syndrome of cardiovascular risk factors, all of which are gcnctically linked and all of which contribute to the development of cardiovascular disease in these patients. Included in the hypertension syndrome are abnormalities of lipid profile, insulin resistance, obesity, changes in renal function, left ventricular hypertrophy and reduced arterial compliance. In many paticnts, these associated cardiovascular risk factors precede the devclopmcnt of high blood pressure by inany years. T h e recognition of t h e hypertension syndrome has resulted in a change of approach towards hypertensive patients. Selcction of drugs for the treatment of hypertensive patients should be made in such a way that effective blood pressure control is achieved but the drugs have, at the same time, a beneficial or, at very least a neutral, cffect on associated risk factors. T h i s change in the management of hypertension may result in a significant impact on the incidence of coronary artery disease among hypertensive patients.