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Exacerbation of Atherosclerosis by Hypertension: Potential Mechanisms and Clinical Implications

Gregory Y. H. Lip, MD, MRCP, DFM, FACA, FACC
Arch Intern Med. 1997;157(11):1265-1266. doi:10.1001/archinte.1997.00440320175018.
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I I with interest the comprehensive review by Chobanian and Alexander1 on potential mechanisms and clinical implications of the development of atherosclerosis in patients with hypertension. A further mechanism for the "exacerbation of atherosclerosis" in patients with hypertension that was not addressed in an otherwise excellent review is the prothrombotic (or thrombogenic) state in hypertension. The process of atherosclerosis (atherogenesis) is closely related to thrombogenesis, and accumulated evidence does suggest that patients with hypertension demonstrate rheological and coagulation abnormalities that are indicative of a prothrombotic or hypercoagulable state.2-5 Such abnormalities are thought to explain why, despite the arterial tree being exposed to high pressures, the complications associated with hypertension (such as heart attacks and strokes) are paradoxically thrombotic rather than hemorrhagic.2 Hypertensive patients with left ventricular hypertrophy, who are at particularly high risk for cardiovascular complications, exhibit additional abnormalities of clotting factors that have been related to

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