Hypertension

Hypertension

Hypertension is an important risk factor for stroke, renal disease, coronary artery disease, peripheral arterial disease, left ventricular hypertrophy and congestive heart failure. Various cardiovascular complications of hypertension can cause significant morbidity and mortality.

Good control of hypertension reduces the stroke incidence by 35–40%, myocardial infarction by 20–25% and heart failure by 50%.

In spite of increasing awareness of hypertension and the availability of better drugs, the control rates of hypertension is far from satisfactory.

While the awareness percentage rose from 51 in 1980s to 70 in 2000, the control rates were only 34 percent in 2000.

Joint national committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC 7)

Joint national (US) committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC 7) has classified hypertension as follows:
Normal: systolic BP <120 mm Hg and diastolic BP <80 mm Hg.
Prehypertension: systolic BP between 120 – 139 mm Hg and diastolic BP between 80 and 89 mm Hg.
Stage 1 hypertension: systolic BP between 140 – 159 mm Hg and diastolic BP between 90 – 99 mm Hg.
Stage 2 hypertension: systolic BP > 160 mm Hg and diastolic BP > 100 mm Hg.

Key messages from JNC 7:

Systolic BP is a more important cardiovascular risk factor in those who are 50 years or more. Cardiovascular risk doubles with each increment of 20/10 mm Hg of BP. Prehypertensives require therapeutic lifestyle modifications to prevent cardiovascular disease.

The term prehypertension has been dropped in the 2017 ACC/AHA guidelines [1] in which elevated blood pressure is between 120-129 mmHg systolic and diastolic below 80 mm Hg. Systolic blood pressure 130-139 mmHg or diastolic between 80-89 mmHg is Stage 1 hypertension. Systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg is termed Stage 2 hypertension.

Reference

1. Paul K Whelton, Robert M Carey, Wilbert S Aronow, Donald E Casey Jr, Karen J Collins, Cheryl Dennison Himmelfarb, Sondra M DePalma, Samuel Gidding, Kenneth A Jamerson, Daniel W Jones, Eric J MacLaughlin, Paul Muntner, Bruce Ovbiagele, Sidney C Smith Jr, Crystal C Spencer, Randall S Stafford, Sandra J Taler, Randal J Thomas, Kim A Williams Sr, Jeff D Williamson, Jackson T Wright Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):2199-2269.