Primary prevention of coronary heart disease in hypertension

MORTALITY FROM MYOCARDIAL INFARCTION: Primary prevention of coronary heart disease in hypertension is important because the mortality among those who have suffered a myocardial infarction is around 50% within 1 month of the infarction. Although the mortality of those who reach hospital has about halved over the last decade (to about 8%), prevention is the only way to affect coronary mortality overall. OVERALL PREVENTION OF CORONARY HEART DISEASE: There are several proven strategies, involving both drugs and lifestyle changes. Stopping smoking is the most powerful, but exercise and reduction of dietary fats and salt are also important; the latter will need co-operation with the food industry. TREATING HYPERTENSIVES WITH A CORONARY RISK: Lipid-lowering drugs will be needed for some, but not all hypertensives, depending on the coronary risk. Some drug treatments which lower blood pressure (e.g. short-acting formulations of nifedipine) may not reduce the coronary risk; further data or newer preparations are awaited. Potassium-sparing diuretics (particularly in elderly patients) and/or beta-blockers remain the first choice for primary prevention. If a calcium channel blocker is needed, verapamil or diltiazem are useful in patients with no left ventricular dysfunction.