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March 22, 1999

Antihypertensives: Much Ado About Lipids

Arch Intern Med. 1999;159(6):535-537. doi:10.1001/archinte.159.6.535

THE QUESTION of what blood pressure medication to use in which patient remains one of great interest and concern; Lakshman et al1 in this issue of the ARCHIVES address 1 factor that some clinicians may use in guiding their antihypertensive medication decision: the effect of these medications on the lipid profile.

Lipids have repeatedly been shown to predict cardiovascular events; and lipid reduction, particularly with use of statins, has been shown to produce potent benefit to overall as well as cardiovascular mortality rates in middle-aged men with heart disease,2 and to benefit cardiovascular events in other groups.2,3 Even in those with "normal" lipids, lipid reduction using statins has led to outcome benefits in those at highest risk of cardiovascular disease4 (although statins may exert some of their benefit through nonlipid mechanisms5). For these reasons, interest attaches to effects of antihypertensives on lipids, particularly because patients with hypertension are at heightened risk for cardiovascular disease, and it is for patients at higher risk for coronary heart disease (CHD) that lipid therapy produces the greatest absolute benefit.6