Hypertension and coronary heart disease

The association of hypertension and coronary heart disease is a frequent one. There are several pathophysiologic mechanisms which link both diseases. Hypertension induces endothelial dysfunction, exacerbates the atherosclerotic process and it contributes to make the atherosclerotic plaque more unstable. Left ventricular hypertrophy, which is the usual complication of hypertension, promotes a decrease of ‘coronary reserve’ and increases myocardial oxygen demand, both mechanisms contributing to myocardial ischaemia. From a clinical point of view hypertensive patients should have a complete evaluation of risk factors for atherosclerosis, damage of arterial territories other than the coronary one, and of the extension and severity of coronary artery involvement. It is important to emphasise that complications and mortality of patients suffering a myocardial infarction are greater in hypertensive patients. Treatment should be aimed to achieve optimal values of blood pressure, and all the strategies to treat coronary heart disease should be considered on an individual basis.