The emergent cardiovascular risk factors and organ damage in arterial hypertension

Correction of cardiovascular risk factors is a mainstay of the treatment of hypertensive patients that have developed or might develop target organ damage. In addition to traditional risk factors, such as smoking, diabetes, obesity, and dyslipidemia clinical research has identified additional conditions that put patients at a greater risk of developing cardiovascular disease and that might achieve particular relevance in the hypertensive state. Over the last decades, effective intervention in the treatment of traditional risk factors has reduced remarkably cardiovascular morbidity and mortality, but the incidence of coronary artery disease, stroke, and renal failure remain unacceptably high. Emerging cardiovascular risk factors are likely to contribute substantially to this picture and it could be anticipated that their contribution will become increasingly evident in the future. Physicians involved in the field of hypertension and dealing with problems concerning cardiovascular prevention should be aware of these new risk factors, give them an appropriate consideration, and correct them when possible. This review will consider the literature supporting the role of lipoprotein(a), homocysteine, and fibrinogen as contributors to cardiovascular risk in the general population and, more specifically, to the development and progression of target organ damage in hypertensive patients. The impact of early impairment of renal function on these factors will be analyzed in relation to the progression of renal disease as found in patients with hypertensive nephrosclerosis.