ADVANCES IN THE PRIMARY AND SECONDARY PREVENTION OF CORONARY HEART-DISEASE

Primary prevention of coronary heart disease by reduction of population risk has been highly successful. The best regimen for controlling elevated blood pressure remains controversial, despite recent guidelines. The reported incidence of left ventricular hypertrophy has increased with the improved ability to detect it using echocardiography. The metabolic abnormalities associated with hypertension (Syndrome X) may have a profound impact on the choice of antihypertensive treatment. How much to lower elevated blood pressure and cholesterol remains clouded by the possibility of a J-shaped curve, indicating increased risk in excessive reduction. Secondary prevention has recently been made more feasible with the recognition that angiotensin-converting enzyme inhibitors exert a beneficial effect in patients with reduced ejection fraction following myocardial infarction.