Is hypertension really a major risk factor for CAD ?
- Yes it is !
- No . . . it is not !
- May be !
- I don’t think so !
Ans : Any of the above can be a right response , depending upon our basal and perceived level of knowledge .
- SHT is one of the risk factor for CAD agreed , but definitely not a major one , as SHT per-se rarely precipitate a STEMI
- Unless SHT occurs with dyslipidemia, smoking or diabetes it is rare to cause ACS.
- The only adverse effect of SHT is , it has a potential to aggravate atherosclerosis by promoting epithelial injury and dysfunction.
- Hypertension is a well known major risk factor for cerebro vascular disease while it is minor risk factor for CAD !
- We do not know yet why cerebral vessels are intolerant to high blood pressure while coronaries are pretty happy with it !
SHT is not a major risk factor for CAD ! At worst , it can propagate chronic CAD. This sort of reasoning may be considered a huge controversy . . .but it is really not !
- One evidence for the above observation is , we have been struggling hard for over a half a century to prove a elusive point that controlling blood pressure to optimal levels would dramatically reduce cardiac events !
- Further,HT’s relationship with acute coronary syndrome especially STEMI is vague , it is very rare for patients with accelerated hypertension or malignant hypertension to present with STEMI *
* Caution :Young doctors should not get confused with this seemingly controversial observation .This write-up , tries to convey a point , SHT may not be that bad for coronary arteries when compared to cerebral arteries . However BP control remains vital in all patients who have developed a cardiac event or in patients with multiple risk factors .
Please note ** SHT is still a powerful risk factor for cardiac failure.(Acute LVF to be precise ) ***SHT can aggravate unstable angina , but very rare to precipitate unstable angina.**** SHT ./High intra-coronary pressure can theoretically dissect or fissure a plaque . (The fact that , HT is so prevalent in a community but spontaneous coronary dissections are not ! should make us think further !)