Non-Invasive Hemodynamic Analyses to Guide Pharmacotherapy of High Blood Pressure: Mini-Review-Juniper Publishers
JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF CARDIOLOGY &
CARDIOVASCULAR THERAPY
Various studies showed the possibility of the Risk
Factors to promote a disease in the arterial wall and the following
development and progression of the Atherosclerosis with its impact on
future vascular events. The early stage of atherogenesis is the
atherosclerotic plaque, and the primary-prevention had already proved
itself efficacius in this early stage, because its erosion and rupture
can lead to thrombus formation on the site of the plaque and vessel
occlusion, culminating in Cardiovascular disease (CVD) with a variety of
clinical manifestations. The most significant clinical manifestation,
in terms of morbility and mortality, is CHD.
The aim of the primary-prevention, dietary and
lifestyle changes is the regression or slow-down and stability of
atherosclerotic plaques, with the control of cardiovascular risk
factors.
Various studies showed the possibility of the Risk
Factors to promote a disease in the arterial wall (inflammation promoted
by T-cell mediated immune responses against antigens such as oxidized
low density lipoprotein- ox LDL -) and the following development and
progression of the Atherosclerosis with its impact on future vascular
events.
The early stage of atherogenesis is the
atherosclerotic plaque, and the primary-prevention had already proved
itself efficacius in this early stage.
In the advanced stages of atherogenesis, that has
been revealed as a complex process, the further lipid accumulation in
the plaque and its progression and gradual increase in size, cause a
reduction in lumen size of the artery (the stenosis with a following
reduction in blood flow), preceded and accompanied by inflammation: the
endothelium responds to damage by inducing a protective response,
eventually leading to the formation of the atherosclerotic plaque, and
the clinical outcome often depends on the stability of the plaque. The
less stable the plaque, the more susceptible it is to erosion or
rupture. Both erosion and rupture can lead to thrombus formation on the
site of the plaque and vessel occlusion, culminating in Cardiovascular
disease (CVD) with a variety of clinical manifestations, including:
- Coronary heart disease (CHD): angina pectoris, myocardial infarction, sudden cardiac death.
- Cerebrovascular disease: transient ischaemia attacks (TIA), stroke.
- Peripheral vascular disease (PVD): intermittent claudication, gangrene.
The most significant clinical manifestation, in terms of morbility and mortality, is CHD.
The aim of the primary-prevention, dietary and
lifestyle changes, is the regression or slow-down and stability of
atherosclerotic plaques, with the control of cardiovascular risk
factors.
Risk Factors for Cardiovascular DiseaseNon-modifiable Risk Factors
- Age
- Gender
- Personal history of CVD
- Family history of CVD Ethnic race
- Smoking
- Dyslipidaemia
- Hypertension
- Diabetes Mellitus
- Overweight/Obesity
- Dietary factors
- Physical inactivity
- Excess alcohol consumption
- Thrombogenics factors
- Stress
Some of the risk factors that predispose an individual to
the development or progression of CVD are outlined above.
Evidence has shown that lifestyles associated with a “western”
culture such as a diet rich in saturated fats and high in calories,
smoking and physical inactivity, are some of the modifiable risk
factors leading to an increase in the prevalence of CVD. Of these,
three are considered to be of prime importance:
Smoking is responsible for 50% of all avoidable deaths, of
which half are due to CVD.
Raised blood pressure has been found to be an important
risk factor for the development of CVD, heart failure and
cerebrovascular disease. The greater the increase in blood
pressure, the higher the risk. Greatest benefit of blood pressure
lowering is seen in patients at higher risk, and even its modest
reductions produce substantial benefits in those with multiple
risk factors.
Dyslipidaemia in particular, raised low-density lipoprotein
(LDL) cholesterol and triglyceride levels, and low high-density
lipoprotein (HDL) cholesterol are associated with increased risk
of CVD.
Multiple risk factors for CVD are usually present in an
individual; rarely do they occur in isolation. When risk factors
co-exist the effect is often exponential; their combined effect is
greater than the sum of their individual effects.
Multiple risk factors are also associated with the
metabolic syndrome which is characterised by dyslipidaemia,
hypertension, insulin resistance, visceral distribution of body
fat, and a prothrombotic state.
Lifestyles and a diet poor in saturated fats and low in
calories (Mediterranean Diet) are very important to control the
modifiable risk factors.
- Smoking cessation
- Weight reduction (and with stabilization)
- Reduction of excessive alcohol intake
- Physical exercise
- Reduction of the stress factors
For a correct one and it heals feeding, is important reduction
of salt intake, to prefer foods of vegetable origin (with decrease
in saturated and total fats intake) regarding those of animal
origin.
The foods of vegetable origin: (fresh fruit and vegetables,
olive oil, pulses, etc) are poor of cholesterol and much poor
of saturated fats (that they stretch to elevate the levels of
cholesterol in the blood).
The foods of animal origin: (meat, milk, cheeses, eggs,
butter, etc), excluded the fish and the crustaceans, are instead
rich of saturated fats.
Rich in vegetables, fruits, cereal grains, legumes, fish, and
olive oil, (two trials have shown that virgin olive oil protects
against insulin resistance and the metabolic syndrome) and
low in meat intake, the Mediterranean Diet has been found to
be protective against coronary death. It also has been associated
with a reduction in diabetes incidence among patients who have
survived myocardial infarctions.
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