Hypertension and cardiovascular disease

1. Hypertension is an important risk factor for morbidity and mortality both from CHD and stroke. 2. A number of factors are associated with the manifestation of hypertension in susceptible individuals, including obesity, a high sodium intake, age, gender, race, and the use of some medications. 3. A new classification of hypertension has been developed by the JNC. It consists of four stages based on levels of both DBP and SBP. 4. Proper measurement of blood pressure is essential to avoid overtreatment and unnecessary labeling. The patient should rest 5 minutes before the measurement and the DBP should be defined as the disappearance of sound (phase V). 5. Treatment of hypertension should begin with nonpharmacological interventions, including weight reduction and dietary sodium reduction to 2300 mg per day. 6. If nonpharmacological interventions are unsuccessful, pharmacological therapy should be initiated with adequate follow-up monitoring. A number of clinical trials have shown that drug treatment (with diuretics and/or beta blockers) reduces morbidity and mortality from both CHD and stroke. 7. The choice of antihypertensive agent should be guided by the stage of hypertension, presence of other risk factors, and particular patient characteristics such as the presence of other disease conditions. Therapy should begin with the lowest effective dose. 8. African-American men respond better to calcium channel antagonists; young white men respond better to ACE inhibitors; older white men respond better to beta blockers. The JNC recommends either a diuretic or beta blocker as initial therapy because they are the only ones tested in large clinical trials. 9. Data on women and ethnic groups are insufficient to recommend specific approaches for them. Treatment usually follows guidelines extrapolated from those for white males. 10. Primary prevention should be a goal for the population as a whole and should he attempted in persons with high normal blood pressure or a family history of hypertension, using lifestyle modifications recommended for patients with frank hypertension.