Atacand-hctz (Candesartan, Hydrochlorothiazide)
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HEART ATTACK AND HIGH BLOOD PRESSURE
The higher the blood pressure, the greater the chance of subsequently developing coronary heart disease, and the greater the chance of dying from it. This is equally true of high systolic pressure and high diastolic pressure. The risk is greater when blood pressure is very high, but it is still recognizably higher in someone with so-called ‘mild’ hypertension than when the pressure is lower. In a very real sense, there is no such thing as benign or mild high blood pressure; over a wide range, the lower the blood pressure the better for one’s heart and circulation.
High blood pressure can harm the heart in at least three ways. Hypertension increases the work load of heart muscle – the heart has to pump against a higher resistance. And, just as with other muscles, this leads to thickening of the heart muscle; this means that the blood flowing through the coronary arteries has to serve the needs of a larger territory. If the coronary arteries are narrowed by atherosclerosis the thickening heart muscle may outstrip its own blood supply. High blood pressure also accelerates the development of atherosclerosis, narrowing the coronary arteries. This was clearly shown in the International Atherosclerosis Project, as described by Dr McGill.
Normal blood pressure is higher than the pressure within the tissues of the body. This causes most substances dissolved in blood plasma to filter slowly from the blood into the walls of the arteries. Among the substances in plasma are the cholesterol-bearing particles or lipoproteins referred to earlier. Normally these lipoproteins can slowly filter away from the artery wall into the lymphatics, so that little or none accumulate. But in hypertension, we can picture the high pressure increasing the rate of filtration, so that more cholesterol is carried into the wall of the artery. This may outstrip the rate at which the artery gets rid of cholesterol; this would favour the development of atherosclerosis.
We have seen how the likelihood of coronary heart disease was especially increased when two or three risk factors were present, particularly the dangerous triad of a high cholesterol level, cigarette smoking and high blood pressure. Now we can see why this may be. Cholesterol appears to be carried into the wall of the artery in the form of lipoproteins from the blood. If the amount of certain cholesterol-rich lipoproteins in plasma is excessive, more cholesterol is likely to be deposited in the artery wall. This is likely to occur at a still greater rate when the blood pressure is high, for it leads to more rapid filtration of lipoproteins into the wall of the artery. The role of smoking is not completely understood, but one effect may be to increase the permeability of the arterial lining, so allowing increased filtration of lipoproteins.
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