Primary prevention of coronary heart disease in hypertension

Mortality from myocardial infarction Primary prevention of coronary heart disease in hypertension is important because the mortality among those who have suffered a myocardial infarction is around 50% within 1 month of the infarction. Although the mortality of those who reach hospital has about halved over the last decade (to about 8%), prevention is the only way to affect coronary mortality overall. Overall prevention of coronary heart disease There are several proven strategies, involving both drugs and lifestyle changes. Stopping smoking is the most powerful, but exercise and reduction of dietary fats and salt are also important; the latter will need co-operation with the food industry. Treating hypertensives with a coronary risk Lipid-lowering drugs will be needed for some, but not all hypertensives, depending on the coronary risk Some drug treatments which lower blood pressure (e.g. short-acting formulations of nifedipine) may not reduce the coronary risk; further data or newer preparations are awaited. Potassium-sparing diuretics (particularly in elderly patients) and/or beta-blockers remain the first choice for primary prevention. If a calcium channel blocker is needed, verapamil or diltiazem are useful in patients with no left ventricular dysfunction.