Hypertension and atherosclerosis: causality or causelessness?

BACKGROUND The close relationship between high blood pressure (BP) and atherosclerosis (ATS) is showed by several data. Instead, less information exists about the several factors which play a role in the interaction between these two pathologies.
AIM OF THE STUDY To overview the possible mechanisms which explain the close relationship between high BP and ATS and to hypothesise the potential influence on the clinical practice.
DISCUSSION Endothelial dysfunction, insulin-resistance and chronic inflammation are involved in the ethiopathogenesis and complications of high BP and ATS. In the last years the interest about protective effect of anti-hypertensive therapy versus ATS, stroke and peripheral arteriopathy is growing up. Several studies reported that calcium channel blockers (CCB), dihydropiridines and not, are able to prevent or to induce the regression of atherosclerotic plaque. Also ACEinhibitors and angiotensin-receptor blockers (ARB), although with less consensus, have demonstrated to slow atherosclerotic process and reduce organ damage. On the other hand, therapies reducing cholesterol, namely statins, have showed to reduce BP. Such effect seems to be due not only to cholesterol reduction but also to direct effect on endothelium.
CONCLUSIONS The availability of drugs, which positively influence both BP and ATS in the same time, helps to treat globally the cardiovascular risk instead of correcting singularly the single risk factors.