Epidemiological studies have shown that hypertension is an independent risk factor for coronary heart disease. In China, 36% of coronary heart disease cases are related to hypertension. Coronary heart disease caused by hypertension is 2-4 times more common than in individuals with normal blood pressure. Hypertension affects the endothelium and smooth muscle cells of blood vessels, causing changes in the arterial wall (thickening of the intima and increased connective tissue), resulting in arterial wall thickening, narrowing of the lumen, and the development of atherosclerosis. When the lumen of the coronary artery is narrowed by more than 75%, angina pectoris occurs clinically. Complete obstruction of the coronary artery leads to localized myocardial infarction and acute myocardial infarction. The higher the blood pressure level, the more severe the atherosclerosis, and the higher the risk of death from coronary heart disease. If other risk factors such as diabetes and abnormal blood lipids coexist, the chance of developing coronary heart disease is significantly increased. Although hypertension is an independent risk factor for coronary heart disease, its strength in causing coronary heart disease is weaker compared to causing stroke. Effective antihypertensive treatment alone can significantly reduce the occurrence and mortality of stroke, but it does not significantly reduce the occurrence and mortality of coronary heart disease. Therefore, the prevention of coronary heart disease requires simultaneous intervention in other risk factors such as diabetes, abnormal blood lipids, and smoking. When choosing antihypertensive drugs, caution should be exercised. Diuretics and beta blockers can interfere with blood lipids, blood glucose, and electrolytes, so long-acting calcium channel blockers and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers should be preferred. However, beta blockers are still the first choice for antihypertensive drugs, especially in the presence of heart failure and arrhythmias after myocardial infarction.
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