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General Considerations

At a population level increasing levels of blood pressure are associated with greater rates of adverse cardiovascular events. These events become more evident at levels greater than 120/80 mm Hg, but traditionally the term hypertension has been reserved for blood pressure levels at or above 140/90 mm Hg. Most guideline committees recommend pharmacologic treatment for blood pressure levels at or above 140/90 mm Hg in persons that have not responded to non-pharmacologic interventions or in the presence of major comorbid conditions.

The prevalence of hypertension varies with age and sex. A 2014 report of data from the National Health and Nutrition Examination Study (NHANES) estimated that 30% of adult Americans have hypertension with the prevalence increasing with age and reaching 70% in persons aged 75 years and above. At all ages and in both sexes African–Americans continue to have a higher prevalence of hypertension in the United States than all other racial/ethnic groups. In African–Americans hypertension tends to develop at an earlier age and tends to be more severe than in other racial/ethnic groups. Some patients with systemic hypertension will have a specific identifiable cause for the elevated systemic blood pressure. The estimated proportion of the cases of secondary hypertension among patients with systemic hypertension ranges from about 5% to 10% and has not been shown to exhibit racial predilection. Patients with secondary hypertension usually exhibit suggestive constellations of signs, symptoms and/or laboratory abnormalities on initial evaluation and should undergo further evaluation for specific causes of hypertension regardless of their race and/or ethnicity. Despite these differences there are no major differences in recommended target blood pressure goals or class of antihypertensive therapy for African–Americans. Although some studies demonstrated differences in level of blood pressure response to certain medications by race, there appears to be no difference in hard outcomes such as cardiovascular events and mortality. Thus a summary of key recommendations from several current reports and guidelines on the treatment of high blood pressure are shown in Table 42–1.

Table 42–1.A summary of key recommendations for the treatment of high blood pressure (BP) from several professional organizations.

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