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At the interface of hypertension and coronary artery disease

ESC Congress 2010

Hypertension


F.E. Rademakers (Leuven,BE) focused on the "vulnerable plaque - vulnerable patient" paradigm, trying to show that in this population of mainly asymptomatic patients, we need to identify patients at high risk in need of specific diagnostic and therapeutic approaches, using both non-invasive biomarkers and imaging. Plaque imaging is important for research to define eligible targets and to evaluate specific general or local treatment strategies. Calcium scoring can support risk stratification. Ischemia imaging is the guide to justify coronary intervention.

S.E. Kjeldsen (Oslo, NO) started with the results of the Euroaspire Study showing that about 60% of coronary patients in Europe remain with uncontrolled hypertension. This is in deep contrast to the well known facts that hypertension is the most prevalent risk factor and an average of at least 3 antihypertensive drugs are needed to control the high blood pressure in patients with both diseases. Beta-blockers are first line treatment but alternative first line or add-on drugs include calcium antagonists, ACE inhibitors or ARBs.

Cardiovascular risk increases as blood pressure (BP) rises, pointed out M. Dorobantu (Bucharest, RO) in her lecture. There is still controversy over the BP targets in patients with coronary artery disease (CAD). Current recommendations can be only based on the analysis of epidemiological studies and post-hoc analyses of large clinical trials. The answer to the question of whether aggressively lowering BP in patients with CAD can be dangerous remains open. Also, there is an issue as to whether a J-curve exists for cardiac events and diastolic BP in CAD patients. More than that, in high-risk patients there is a "ceiling effect“ for treatment benefits.

L. Vanhees (Leuven, BE) first elucidated the role of physical fitness in hypertension and in CAD; in the definition of cardiac rehabilitation (CR) the role of exercise was highlighted. There is an inverse graded association between fitness category and development of hypertension. Both endurance and dynamic resistance training result in a significant increase in peak VO2 and induce a significant reduction in systolic and diastolic BP. CR including exercise results in a significantly larger reduction in all-cause and cardiac mortality and a greater BP reduction. The analysis of Dr. Vanhees’ own as yet unpublished data showed that CR induces a greater reduction in SBP and heart rate in patients with CAD and hypertension compared to normotensive patients with CAD. No differences in peak VO2 were observed.

References


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At the interface of hypertension and coronary artery disease

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.