Cardiovascular morbidity and mortality in high-risk populations: epidemiology and opportunities for risk reduction.

Despite significant growth in the number of drug classes and individual agents available to combat various cardiovascular (CV) risk factors in clinical practice, the prevalence of these risk factors, including hypertension, diabetes mellitus, and obesity, has remained largely unchanged and in some cases has even increased during the past decade. CV risk factors remain consistently undertreated across the world, despite consensus guidelines issued by national and international health care organizations. Given the earlier onset of obesity and diabetes mellitus in many national populations, beginning from childhood, it is desirable to implement a range of lifestyle and pharmacologic interventions intended to modify CV risk factors while also improving glucose tolerance. Drugs that block the renin-angiotensin system are associated with reduced incidence of diabetes compared with other antihypertensive agents and should be considered mainstays of therapy for patients with hypertension who are at high risk for diabetes, CV disease, or both.