How does hypertension affect coronary heart disease? Analysis of treatment strategies for complications.

What are the effects of hypertension on coronary heart disease?

The incidence and mortality of coronary heart disease increase with rising blood pressure. Elevated blood pressure damages the vascular endothelium, leading to thrombus formation and plaque formation. Long-term elevated blood pressure also causes left ventricular hypertrophy and myocardial fibrosis, resulting in poor myocardial blood supply and coronary heart disease. Therefore, patients with coronary heart disease and hypertension should actively treat their blood pressure.

How to treat hypertension complicated by coronary heart disease?

Hypertension can develop into coronary heart disease over a long period. Of course, not all patients with coronary heart disease have hypertension. If hypertension has been complicated by coronary heart disease, in addition to actively treating blood pressure, other conditions should also be actively addressed. Furthermore, the selection of antihypertensive drugs has its specific characteristics. Specific measures are as follows:

(1) Selection of antihypertensive drugs: Because β-blockers have multiple cardioprotective effects such as slowing heart rate, reducing myocardial oxygen consumption, and resisting myocardial ischemia, they should be the first choice for treating coronary heart disease. Secondly, long-acting calcium channel blockers and ACEIs and ARBs are also used. For hypertensive patients after myocardial infarction, aldosterone receptor antagonists can also be used.

(2) Lipid-lowering therapy: The pathological basis of coronary heart disease is atherosclerotic plaques. Statins have the effects of inhibiting inflammation, stabilizing plaques, and shrinking plaques. Long-term use can improve prognosis and is an indispensable drug in the treatment of coronary heart disease.

(3) Antiplatelet therapy: The initiating factor of cardiovascular events is platelet aggregation. Patients with coronary heart disease who have well-controlled blood pressure need antiplatelet therapy. Representative drugs are enteric-coated aspirin 75-150mg and clopidogrel 75mg. The dosage should be increased accordingly in the acute phase.

What are the precautions for using aspirin? Aspirin has a very positive effect on the prevention and treatment of cardiovascular and cerebrovascular diseases. Simply put, it prevents thrombosis by effectively inhibiting platelet aggregation, the initiating factor of cardiovascular and cerebrovascular events. When cardiovascular diseases (including coronary heart disease, myocardial infarction, ischemic stroke, transient ischemic attack, peripheral arteriosclerosis, etc.) are stable, 75-150 mg/day can be used, which is the so-called low dose (compared to the 300 mg used for antipyretic analgesia). During an acute attack, a loading dose of 300 mg/day should be given initially, followed by a low maintenance dose of 75-150 mg/day.

Aspirin inhibits platelet aggregation and can prevent thrombosis. Some people are overly sensitive, or for other reasons, bleeding may occur. Those with poorly controlled blood pressure (>150/90 mmHg), active peptic ulcers, severe liver disease, bleeding disorders, or those using other anticoagulants are more prone to bleeding. Therefore, these individuals should use it with caution or avoid it altogether.