Hypertension is the most common primary diagnosis in the United States, accounting for 35 million office visits annually. It is a leading risk factor for cardiovascular disease and is the leading cause of death in the United States. Of these deaths, 83% are caused by myocardial infarction and 17% from stroke, although there has been a steady decline in those statistics because of the lowering of blood pressure in the general population.
Family history of premature cardiovascular disease (men age < 55, women age < 65)
Cigarette smoking
Reprinted courtesy of the U.S. Dept. of Health and Human Services, NIH Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), NIH Publication No. 03-5231, May 2003.
Hypertension is defined as a consistently elevated systolic blood pressure and/or diastolic blood pressure on two or more occasions. Approximately 50 million people have hypertension. Variation exists in the prevalence and consequences of hypertension among different age, gender, and racial and ethnic groups. There is an increasing incidence of hypertension with increasing age.
Hypertension tends to occur at an earlier age in African Americans. The incidence is higher in men than in women until the age of 55, and then the risk is about equal until age 74, after which point women have a higher incidence than men. African Americans have a much higher prevalence, more severe hypertension, and diagnosis at a later stage than whites. The greater severity is accompanied by a much higher rate of stroke mortality, heart disease, and hypertension-related end-stage renal disease. Hispanics have the same or lower prevalence of hypertension despite a high prevalence of obesity and diabetes.
There is an increasing incidence of hypertension with increasing age.
Cardiac complications are the major causes of morbidity and mortality in essential hypertension. Hypertension is the major predisposing cause of stroke and is the second most common antecedent of end-stage renal disease.
Hypertension-related consequences of cardiovascular disease, stroke, and end-stage renal disease make hypertension a major public health concern. Cardiac disease and stroke are the first and third leading causes of death in the United States, respectively. Cardiac complications are the major causes of morbidity and mortality in essential hypertension. Hypertension is the major predisposing cause of stroke and is the second most common antecedent of end-stage renal disease.
Various methods of classification for hypertension based on pathology, severity, and associated risk factors are used to give direction to interventions. It is estimated that 95-99% of people with hypertension have no identifiable cause for it. This is known as primary or essential hypertension. Primary hypertension may be controlled, but the predisposition remains. Secondary hypertension results from a known cause such as renal disease or primary aldosteronism and constitutes 5% to 8% of all hypertensive individuals. It is caused by altered hemodynamics associated with a primary disease or condition that, when removed, results in cure of the hypertension if it has not been prolonged. Isolated systolic hypertension, an elevation of systolic pressure with a normal diastolic pressure, is common in the elderly and appears to be a significant cardiovascular risk factor.
Isolated systolic hypertension, an elevation of systolic pressure with a normal diastolic pressure, is common in the elderly and appears to be a significant cardiovascular risk factor.
A commonly recognized classification of hypertension according to level of blood pressure elevation is shown in Figure 35-2. Because risk for cardiovascular disease in individuals with hypertension is determined not only by the level of blood pressure elevation but also by other risk factors and end-organ damage, a cardiovascular risk stratification classification for hypertension has been developed to guide treatment and is shown in Figure 35-1.
Figure 35-1 Diagnostic workup of hypertension.
Table 35-2 JNC 7 Classification of Blood Pressure (BP)
Category
Systolic Blood Pressure (mm Hg)
Diastolic Blood Pressure (mm Hg)
Normal
<120 and
<80
Prehypertension
120-139 or
80-89
Hypertension, stage 1
140-159 or
90-99
Hypertension, stage 2
≥160 or
≥100
When systolic and diastolic blood pressures fall into different categories, the higher category should be selected to classify the individual’s blood pressure status.
Reprinted courtesy of the U.S. Department of Health and Human Services, NIH Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), NIH Publication No. 03-5231, May 2003.
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There is an increasing incidence of hypertension with increasing age.
Cardiac complications are the major causes of morbidity and mortality in essential hypertension. Hypertension is the major predisposing cause of stroke and is the second most common antecedent of end-stage renal disease.
Isolated systolic hypertension, an elevation of systolic pressure with a normal diastolic pressure, is common in the elderly and appears to be a significant cardiovascular risk factor.
