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ROLE OF ARTERIAL HYPERTENSION IN ISCEMIC HEART
DISEASE(IHD) AND PRIMARY PREVENTION IN WOMEN
Xalilov Azizjon Marufjonovich
Vice-rector for treatment of Central Asian Medical University
https://doi.org/10.5281/zenodo.13365097
Annotation
When heart experts talk about prevention, they usually refer to one of
three types: secondary, primary and primordial prevention. All three have
similar elements, but different starting times and different effects.
Primary
prevention aims to keep an individual at risk of heart disease from having a first
heart attack or stroke, needing angioplasty or surgery, or developing some other
form of heart disease. Primary prevention is usually aimed at people who
already have developed cardiovascular risk factors, such as high blood pressure
or high cholesterol.
Key words:
risk factor, heart disease, patients, Women’s Health Initiative
(WHI).
Hypertension (HTN) continues to be a potent and widespread risk factor for
IHD. Among other Framingham risk factors of tobacco use, diabetes mellitus,
dyslipidemia, and left ventricular hypertrophy, HTN plays an independent role
in augmenting IHD risk, as well as a multiplicative role with respect to adverse
outcomes when HTN is present concurrently with the other major IHD risk
factors listed above. Over the past two decades, numerous studies and guideline
reports have been presented with the aims of (a) elucidating the
pathophysiology of IHD, (b) delineating an ideal blood pressure (BP) threshold
at which to institute pharmacotherapy, and (c) defining the optimal
pharmacologic elements of a therapeutic regimen. While there are active
debates surrounding the existence and relevance of the J curve in IHD patients
who have HTN, as well as the numerical level of the BP cutoff justifying drug
therapy in the general population, there is a general consensus that the BP target
in IHD patients should be lower than 140/90 mmHg. The most appropriate class
(or classes) of medication recommended will depend on the comorbid
conditions associated with each individual patient. Overall, however, there is no
major evidence underscoring a significant difference between drug classes,
provided the target BP is achieved, although it should be pointed out that the
most recent (2015) American Heart Association (AHA)/American College of
Cardiology (ACC)/American Society of Hypertension (ASH) guideline statement
now elevates beta-blockers (BB) to the same level of recommendation as other
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classes of hypertension drugs in the treatment of patients who have
hypertension and ischemic heart disease. Although most agents that reduce
blood pressure will correspondingly lower myocardial workload, BB may exhibit
a special advantage in IHD patients because BB (as well as verapamil and
diltiazem subclasses of calcium channel blockers or CCB) act to lower HR as well
as cardiac inotropy. Moreover, BB will remain an integral if not indispensable
part of the management of IHD, especially in those with history of angina
pectoris or MI, based on decades of favorable clinical as well as trial experience.
This extensive salutary historical background has served as a foundation for the
2015 committee's decision to bring BB into the front rank of BP agents for those
hypertensive individuals suffering simultaneously from IHD.
Coronary heart disease (CHD) is a leading cause of death in women.
Observational studies have consistently shown oestrogen to help prevent CHD in
postmenopausal women. The large randomized controlled Women’s Health
Initiative (WHI) trial initially did not confirm these observational findings.
However, further analyses of the WHI study as well as metaanalyses of
randomised clinical trials of hormone replacement therapy (HRT) and of the
observational Nurses’ Health Study have now found that the timing of onset of
HRT use is important and that oestrogen may have an important protective role
in CHD, particularly in women initiating treatment below age 60 years. This
consensus statement will examine the evidence regarding HRT and non-
oestrogen therapies (lipid lowering agents, aspirin, antihypertensives,
antidiabetic medications, SERMs) as well as diet, lifestyle and smoking cessation
in the primary prevention of CHD in women.
oestrogen may have a protective role in CHD prevention especially if initiated in
women below age 60 years or within 10 years of onset of menopause women
with a premature menopause should take oestrogen to reduce the risk of CHD
lipid-lowering agents are probably beneficial in primary prevention aspirin
cannot be recommended for primary prevention of CHD, but may protect against
stroke treating hypertension reduces the risk of CHD in diabetics, prevention of
CHD is based on management of established cardiovascular risk factors through
both lifestyle measures and pharmacotherapy in metabolic syndrome,
prevention of CHD is based on management of established cardiovascular risk
factors through both lifestyle measures and pharmacotherapy stopping
smoking, reducing obesity, improving diet and undertaking regular exercise are
key lifestyle measures.
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