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High blood pressure (hypertension), like cholesterol, smoking, and alcohol, deserves a chapter of its own in any book on angina. Hypertension causes complications for the heart in two ways: it directly increases the work done by the heart, so that the demand for oxygen is increased, and it accelerates the process of atherosclerosis, so that the coronary vessels in someone with hypertension are even more affected by atherosclerosis, and therefore narrower, than in someone with normal blood pressure.

Hypertension is linked with higher than normal risks of stroke, heart attack, and kidney disease, and it is vital that it should be controlled in anyone with angina. Professor Giuseppe Mancia of the University of Milan, one of the world’s leading experts in the study of hypertension, recently spelled out to me the risks of the combination of hypertension and angina.

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