Hypertension and other risk factors in coronary heart disease.

Whether systolic or diastolic, labile or fixed, at any age in either sex, hypertension is dangerous. Adiposity, heart rate, alcohol intake, hematocrit, blood sugar, serum cholesterol, and triglycerides are all related to the occurrence of hypertension in one or both sexes. These factors also contribute to the occurrence of the cardiovascular sequelae of hypertension. The influence of blood pressure on the incidence of cardiovascular disease is independent of other predisposing cofactors but is greatly affected by them. Elevated pressures are often accompanied by hyperlipidemia, hyperglycemia, elevated fibrinogen, and ECG abnormalities, all of which augment the risk. Coronary disease is now the most common sequela of hypertension, and the excess risk is concentrated in those with an increased low-density lipoprotein/high density lipoprotein ratio, impaired glucose tolerance, and ECG abnormalities, and in cigarette smokers. Hypertension is only a component of a multifactorial coronary risk profile which must be considered when implementing optimal therapy. Both the urgency for treatment and judgment of efficacy should be guided by the multivariate risk profile.