Hypertension : Advanced Reading on Healthline

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Hypertension is an independent risk factor for coronary artery disease (CAD) and stroke, leading causes of morbidity and mortality in North America. Concern has been raised that there is inadequate outpatient detection, evaluation, and treatment of hypertension, and that this is resulting in increased hospital admissions with complications of untreated hypertension: heart failure, and end-stage renal disease [1]. Primary care providers (PCPs) perform 35 million patient visits annually in the United States with a primary diagnosis of hypertension, and there are an estimated 50 million Americans who have hypertension [1]. There has been improvement. Mortality from both stroke and coronary heart disease (CHD) has declined since 1972, and awareness, treatment, and control of hypertension have increased; however, there is much room for further improvement [2]. Based on the National Health and Nutrition Examination Survey (NHANES) results in 1999 and 2000, 70% of those who have hypertension were aware of the condition, with 59% being treated with medication, but only 34% achieving a blood pressure of less than 140/90 mmHg on their current medication [2].

Based on estimates of lifetime risk of developing hypertension among participants in the Framingham Heart Study, we can expect a large increase in the prevalence of hypertension as the population ages [3]. The lifetime risk estimated from this sample is 86% to 90% for women and 81% to 83% for men. The Framingham data have not shown improvement in the prevalence of hypertension over time, in contrast to the data in the NHANES study [2,3] ; however, artifacts in the measurements of hypertension in the early NHANES data are believed to be at least partially responsible for this observed difference [2].

The causes of hypertension and reasons for poor control are multifactorial, including lifestyle choices, culture, and physician awareness. The goal of improving physician awareness and office-based practice in the management of hypertension is to complement public health activities in promoting low-sodium food choices and physical activity, improving patient awareness, and, we hope, compliance with measures to decrease the burden of illness. In this article, the authors review the evidence behind the current definitions of hypertension, and review supporting measures encouraging lifestyle modification and pharmacologic interventions.

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Primary Care: Clinics in Office Practice
By: Denise L. Campbell-Scherer MD, PhD, Lee A. Green MD, MPH
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