HYPERTENSION

Definition and Etiology Normal or optimal blood pressure (BP) is defined as the level above which minimal vascular damage occurs. There is a continuous, consistent, and independent relationship between elevated BP and risk of cardiovascular events. This was clearly demonstrated in a meta-analysis that included 1,000,000 individuals with no history of vascular disease. Among this group, during 12.7 million person-years at risk, there were about 56000 deaths categorized as vascular in origin (12000 stroke, 34000 ischemic heart disease, and 10000 other vascular) and 66000 other deaths at ages 40-89 years.1 Results from this study demonstrated that a BP level lower than 115/75 mmHg appears to better define optimal BP.1 According to the Joint National Committee 7 (JNC 7), hypertension is defined as physician office systolic BP level of 140mmHg and diastolic BP of 90mmHg. The JNC 7 defines normal BP as a systolic BP <120mmHg and diastolic BP <80mmHg. The gray area between systolic BP of 120-139 mmHg and diastolic BP of 80-89 mmHg is defined as prehypertension.2 Back to Top Prevalence and Risk Factors One in 3 Americans over the age of 18 years suffers from hypertension. The prevalence is higher among older individuals, women and non-Hispanic blacks. Despite the increase in prevalence, recent data from the National Health and Nutrition Examination Survey (NHANES) demonstrate an improvement in blood pressure control (50%) among Americans with hypertension.3 However, the blood pressure control rate remains suboptimal in people who have serious comorbid conditions such as chronic kidney disease. In a survey of patients with chronic kidney disease, BP control was found to be just 13.2%.4 On a global level, hypertension is a greater problem, with 13.5% of all deaths attributed to BP-related diseases. Individuals in lower economic strata are disproportionately afflicted with hypertension.5 The prevalence of hypertension increases progressively with age. Results from the Framingham study demonstrate that among middle-aged and elderly persons, the residual lifetime risk of developing hypertension is 90%.6 In the majority of patients (95%), hypertension is primary or idiopathic; there is no identifiable risk factor. The remainder of these patients have hypertension caused by renovascular disease, primary aldosteronism, etc.