Hypertension and coronary heart disease: cause and consequence or associated diseases?

Numerous epidemiologic and experimental studies have shown that increased arterial pressure accelerates atherosclerotic disease including coronary heart disease. Left ventricular hypertrophy also develops along with the development of hypertension. In uncomplicated stages of hypertension, left ventricular hypertrophy may enable the heart to maintain its performance against an increased afterload. Development of coronary heart disease in hypertensive heart disease could be one of the factors that impairs cardiac function in later stages of the disease so that the function of the heart can no longer match the increased afterload. It can also be argued that atherosclerotic disease commonly contributes to an increase in systolic blood pressure. Short-term increases in arterial pressure due to angina pectoris or other stressful events may trigger permanent hypertension; this is an interesting alternative that is yet to be investigated. Thus, it is possible that a cause/consequence relationship is involved between hypertension and coronary heart disease as opposed to a simple association. Furthermore, this cause/consequence relationship could sometimes be bidirectional.