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General Considerations
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Hypertension is a persistent and frequently progressive elevation in blood pressure. The level of systolic and/or diastolic blood pressure at which the elevation assumes the diagnosis of hypertension depends on the presence or absence of coexisting comorbidities. The current classification of blood pressure and the level of blood pressure that defines hypertension for the major comorbid conditions as recommended in the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure are shown in Table 43–1. The prevalence of hypertension varies with age and sex. It is estimated that 23% of adult Americans between the ages of 20 and 74 years have hypertension. About 75% of women aged 75 years and over have hypertension and about 64% of men aged 75 years and over have hypertension. At all ages and in both sexes African-Americans have the highest prevalence of hypertension in the United States. In African-Americans hypertension tends to develop at an earlier age and tends to be more severe than in other races. 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 and/or symptoms on initial evaluation and should undergo further evaluation for specific causes of hypertension regardless of their race and/or ethnicity.
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Hypertension is one of the major risk factors for cardiovascular disease. Uncontrolled hypertension leads to specific target organ damage that contributes to overall cardiovascular morbidity and mortality. African-Americans exhibit a greater increase in target organ damage than other racial and ethnic groups. In fact, the heart disease mortality rate is 50% higher, the stroke mortality rate is 80% higher, and the incidence of hypertension-related end-stage renal disease (ESRD) is 6-fold higher in African-Americans than in whites. It is apparent that hypertension along with its cardiovascular morbidity and mortality is an even greater challenge for the African-American community than it is for the rest of the nation. Many of the factors responsible for the disparities in the incidence, prevalence, detection, treatment, and control of hypertension have been well described and can be useful in the design and development of programs and policies targeted to the diagnosis and control of hypertension within the population.
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