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GENERAL CONSIDERATIONS

Approximately 76.4 million people aged ≥20 years in the United States have hypertension, defined as an average systolic blood pressure of ≥140 mmHg, a diastolic blood pressure of ≥90 mmHg, the current use of blood pressure–lowering medication, and/or being informed twice of the diagnosis by a health care professional. This translates to one in three adults and more than half of those aged >60 years. The incidence of hypertension increases with age. If an individual is normotensive at age 55, the lifetime risk for hypertension is 90%. High blood pressure resulted in the death of 61,005 Americans in 2008. From 1998 to 2008, the death rate from hypertension rose by 20.2% and the actual number of deaths rose by 49.7%. Of persons with high blood pressure, 81% are aware of their diagnosis. Of this group, 72% are under treatment, while only 50% are well controlled. A higher percentage of men than women have hypertension until the age of 45. From the age of 45 to 64, the percentage of men and women affected by hypertension is similar. Above the age of 65, a higher percentage of women than men have hypertension. Although the true incidence of hypertension in children is unknown, the number of hospitalizations for children with hypertension between 1997 and 2006 doubled from 12,661 to 24,602. Hypertension is most prevalent among the African-American population, affecting about 42% of them. Non-Hispanic Afro Americans and Mexican Americans are also more likely to suffer from high blood pressure than non-Hispanic whites. In 2010, the economic cost of hypertensive disease was estimated at $76.6 billion. Nearly 90% of the US adults with uncontrolled hypertension have a usual source of health care and insurance.

Table 35–A

The National High Blood Pressure Education Program (NHBPEP), which is coordinated by the National heart, Lung, and Blood Institute (NHBLI) of the National Institutes of Health, was established in 1972. The program was designed to increase awareness, prevention, treatment, and control of hypertension. Data from the National Health and Nutrition Examination Survey (NHANES), conducted between 1976 and 2008, revealed that of patients aware of their high blood pressure and under treatment, the number who had achieved control of their high blood pressure had increased. Coincident with these positive changes was a dramatic reduction in morbidity and mortality (40–60%), including stroke and myocardial infarction (MI) secondary to hypertension. However, the most recent series of NHANES surveys conducted between 2007 and 2008 continue to show a leveling off of improvement.

High blood pressure is easily detected and usually controlled with appropriate intervention. Of the patients with high blood pressure, 81% are aware of their diagnosis. Among this group, 72% are under treatment, 50% are well controlled, and 50% are not. In addition, the incidence ...

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