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Posts Tagged ‘major vs minor risk factor’

Is hypertension really a major risk factor for CAD ?

    1. Yes it is !
    2. No . . . it is not !
    3. May be !
    4. I don’t think so !

Ans : Any of the above can be a  right response , depending upon our basal and perceived  level of knowledge .

Answer analysis

  1. SHT  is  one of the risk factor for CAD  agreed ,  but definitely not a major one , as SHT per-se rarely precipitate a STEMI
  2. Unless SHT occurs with dyslipidemia, smoking or diabetes it is  rare to cause ACS.
  3. The only  adverse effect of SHT  is  , it has a potential  to aggravate atherosclerosis  by promoting epithelial injury and dysfunction.
  4. Hypertension is a well known  major risk factor for cerebro vascular disease while it is minor risk factor for CAD !
  5. We do not know yet why cerebral vessels are intolerant to high blood pressure while coronaries are pretty happy  with it !

Final comment

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 !)

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