Cardiovascular prevention (VI). Use of drugs in the primary prevention of arterial hypertension and dyslipidemia

Abstract

Arterial hypertension and dyslipidemia are two of the main risk factors for cardiovascular and renal disease in Spain. Lifestyle modification and drug therapy are the mainstays of risk reduction. Both the goals of therapy and the choice of drug treatment, in particular of antihypertensive treatment, are determined by the patient's demographic characteristics, the presence of other cardiovascular risk factors and the coexistence of asymptomatic vascular and kidney disease; that is, by the determinants of overall cardiovascular risk. Although some clinical guidelines exclude beta-blockers from first-line treatment of hypertension because they may have little effect, we believe that the five main classes of antihypertensive drugs currently available could provide first-line therapy since the majority of the hypertensive patients require combination therapy to achieve their blood pressure targets. Statins are fundamental to the pharmacologic treatment of dyslipidemia. Their primary effect is to reduce the plasma low-density lipoprotein level, which has been shown to be closely related to the reduction in cardiovascular risk. Other therapeutic agents include selective cholesterol absorption inhibitors (e.g., ezetimibe), which must be used in combination with statins, and fibrates, whose use is more restricted but which are helpful in patients with hypertriglyceridemia.