The role of arterial hypertension in coronary atherosclerosis Is it really an independent risk factor?

Konstantinos C. Koskinas, Nikolaos Fragakis, Asterios Karagiannis, George D. Giannoglou



Coronary atherosclerosis is a complex process determined by the combined effect of multiple risk factors, including arterial hypertension and dyslipidemia. Recently, the reference values for blood lipid levels and the targets for lipid-lowering therapies for prevention of coronary heart disease have progressively lowered, which has modified the appreciation of how individual risk factors contribute to the global cardiovascular risk. Arterial hypertension plays a major role in the pathobiology of atherosclerosis and it is an important risk factor of ischemic heart disease at a clinical level. Nonetheless, a critical appraisal of emerging evidence indicates that the pro-atherogenic effects of arterial hypertension require presence of dyslipidemia. In this review we discuss experimental and clinical evidence suggesting that hypertension augments the pro-atherogenic effects primarily mediated by lipoproteins, and that it precipitates the anatomic progression and clinical sequelae of coronary atherosclerosis only in the setting of high blood lipid levels. A better understanding of the contribution of arterial hypertension to the development and progression of coronary atherosclerosis may allow for more effective evaluation of the global risk for coronary artery disease, and may optimize targets of blood pressure control in patients with versus those without dyslipidemia to avert cardiovascular complications.

Keywords: Arterial hypertension, Atherosclerosis, Coronary heart disease, Cardiovascular risk