Inflammation is a process by which the body heals itself, however, chronic inflammation is implicated in some disease states, such as rheumatoid arthritis. Recently, atherosclerosis has also come to be understood as an inflammatory disease (1).

C-reactive protein is a measure of inflammation in our bodies, and increased high-sensitivity levels of CRP or hs-CRP, have been shown to predict future heart attacks and strokes in apparently healthy individuals (2). Hypertension or elevated blood pressure is an important risk factor for heart attacks and strokes, so is there a relationship between hypertension and inflammation? Apparently yes. Hs-CRP not only predicts the future development of hypertension (3), but also was found to modify the impact of blood pressure on the risk of strokes, heart attacks and cardiovascular death (4).

It is therefore of interest to know whether treatments to reduce blood pressure can also reduce inflammation, as this may result in added clinical benefit. In the recently published Val-MARC clinical trial, patients with stage 2 hypertension were randomized to receive either the blood pressure-lowering drug valsartan (a type of "ARB" or angiotensin receptor blocker), or a combination of valsartan and another anti-hypertensive drug called hydrochlorothiazide. An interesting finding from this trial was that valsartan reduces not only blood pressure but also inflammation, as reflected by hs-CRP values, and this effect on hs-CRP may be independent of the drug's effect on blood pressure. Dr. Ridker talks about the study some more, as well as implications for future blood pressure trials.

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After viewing this presentation the participant will be able to discuss:

- Inflammation: when it is good and when it is bad
- The relationship of inflammation to the risk of heart attacks and strokes
- The relationship of inflammation to hypertension, a major risk factor for heart attacks and strokes
- The implications of anti-inflammatory effects of some blood pressure-lowering drugs

1. Vincenzo Pasceri, MD; Edward T. H. Yeh, MDA Tale of Two Diseases: Atherosclerosis and Rheumatoid Arthritis Circulation. 1999;100:2124.

2. Paul M. Ridker, M.D., Mary Cushman, M.D., Meir J. Stampfer, M.D., Russell P. Tracy, Ph.D., and Charles H. Hennekens, M.D.Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Healthy Men N Engl J Med. 1997 Apr 3;336(14):973-9.

3. Howard D. Sesso, ScD, MPH; Julie E. Buring, ScD; Nader Rifai, PhD; Gavin J. Blake, MD, MPH; J. Michael Gaziano, MD, MPH; Paul M. Ridker, MD, MPH C-Reactive Protein and the Risk of Developing Hypertension JAMA. 2003;290:2945-2951.

4. Gavin J. Blake, MD, MPH, MRCPI; Nader Rifai, PhD; Julie E. Buring, ScD; Paul M Ridker, MD, MPHBlood Pressure, C-Reactive Protein, and Risk of Future Cardiovascular Events Circulation. 2003;108:2993.

5. Paul M Ridker; Eleanor Danielson; Nader Rifai; Robert J. Glynn for the Val-MARC Investigators Valsartan, Blood Pressure Reduction, and C-Reactive Protein: Primary Report of the Val-MARC Trial Hypertension. 2006;48:73.