Optimizing cardiovascular risk reduction during antihypertensive therapy.

O ver the past decade, pharmacological treat- ment of elevated blood pressure has evolved from empiricism to a more individualized approach based on patient characteristics and an expanding understanding of the impact of specific agents on the pathophysiology of hypertension and, more importantly, cardiovascular disease. Although blood pressure elevation has been shown to be a powerful risk factor for myocardial infarction, stroke, congestive heart failure, and renal failure, as well as several other forms of cardiovascular disease, epidemiological evidence has supported the additive impact of other risk factors as well. The increasing understanding of the hemodynamic and metabolic effects of specific antihypertensive agents, and the recognition that not all effective blood pressure-lowering strategies have been demonstrated to have uniform or consistent benefit in reducing all forms of cardiovascular disease associated with hypertension has forced a critical reevaluation of the effects of specific antihypertensive drugs.