- Prehypertension: systolic pressure of 120–139
mm Hg or diastolic pressure of 80–90 mm Hg.
- Stage 1 hypertension: systolic pressure of 140–159
mm Hg or diastolic pressure of 90–99 mm Hg.
- Stage 2 hypertension: systolic pressure of ≥ 160 mm Hg or
diastolic pressure of ≥ 100 mm Hg.
- Measure on three separate occasions.
- In diabetic patients, diastolic pressure > 80 mm Hg, systolic
pressure > 130 mm Hg, or both, on three separate occasions.
Hypertension is a major modifiable risk factor for cardiovascular disease that can, if untreated, result in serious morbidity and
mortality from cardiac, cerebrovascular, vascular, and renal disease.
In excess of 62 million persons in the United States are estimated
to have hypertension, and only about 70% of these individuals
are aware of their diagnosis. Of those, only a third are at their
therapeutic goal. The potential for death and disability is therefore
quite high and represents a serious public health issue. Once the
diagnosis of hypertension is made and therapy instituted, elevated
blood pressure can be lowered, reducing the risk of cardiovascular
disease in most patients. Major antihypertensive trials, in large
populations, have conclusively demonstrated that there is a direct continuous
relationship between the level of blood pressure and cardiovascular
morbidity and mortality. These studies have shown that treating
all levels of hypertension significantly decreases fatal and nonfatal
stroke, coronary events, heart failure, and chronic kidney disease
and renal failure. The wide array of antihypertensive agents is
very effective in reducing blood pressure. Despite similar blood
pressure and overall mortality reductions, the reductions in incidence
of stroke, coronary ischemic events, heart failure, and renal failure
are not the same for all classes of antihypertensive agents. The
reasons for these differences have not been totally explained and
are the topic of much speculation.
A growing body of direct and inferential evidence suggests that reduction of blood pressure should not be the only goal of antihypertensive
therapy. Therapy should also be directed toward controlling all of the patient’s modifiable cardiovascular risk factors, including dyslipidemia, smoking, obesity, physical inactivity, microalbuminuria, and diabetes mellitus.
Until recently, high blood pressure was synonymous with hypertension; now, however, data suggest that there is considerably more to hypertension than increased blood pressure. Several metabolic and functional
abnormalities have even been observed in the children of hypertensive
patients prior to blood pressure elevation that are similar to,
but of a lesser magnitude than, those found in their parents. Hypertension
is also associated with insulin resistance and glucose intolerance.
Insulin levels are consistently higher in hypertensive patients
than in normotensive persons. Hyperinsulinemia is worsened by thiazide
diuretics, especially in the presence of β-blocker
therapy. Hyperinsulinemia produces a proliferation of vascular smooth muscle
and fibrous tissue and adversely affects the serum lipid profile.
Renin and angiotensin levels are also important factors in determining both the response to therapy and the prognosis. Hypertensive patients
with high renin levels have a greater incidence of myocardial infarction ...