Major risk factors for coronary heart disease in hypertension: implications for management.

Since most deaths attributable to hypertension are the result of coronary heart disease (CHD), the major objective in the management of hypertension should be the prevention of CHD. Data from large population studies, mainly carried out in the USA, leave little doubt that hypertension is causally associated with CHD and we have no reason to believe that the risk factors for CHD in the United Kingdom are any different from those established in the American studies. In addition to the non-modifiable factors of age, sex, and family history, there are modifiable risk factors which include raised serum low density lipoprotein (LDL)-cholesterol, smoking, raised BP, diabetes mellitus, lack of exercise, low high density lipoprotein (HDL)-cholesterol, and use of oral contraceptives. Medicine clearly has a large and critical task in dealing with the current epidemic of CHD-associated illness. However, it is also apparent from prospective data from several countries that a preventative approach by means of public health measures is likely to have a favourable impact upon several of the modifiable risk factors. It is likely that if resources were made available for this purpose in the United Kingdom, a major reduction in morbidity and mortality from CHD would ensue. If we continue to manage hypertension without paying attention to other CHD risk factors, particularly abnormal lipid profiles, then we are unlikely to make an impact on morbidity and mortality from CHD which is our primary objective.