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Overview

Hypertension Overview

  • Currently hypertension is defined as BP equal to or greater then 140/90 mm Hg based on the average of two or more correct BP measurement taken during two or more contacts with health care provider. Higher the BP greater the risk of cardiovascular disease (CVD). 
  • The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg.1
  • Individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension.1
  • Hypertension is a major risk factor for cardiovascular disease.  Approximately 54% of all strokes and 47% of heart disease is attributable to above optimal blood pressure accounting for 7.6 million deaths and 92 million disability-adjusted life  years worldwide each year.2
  • The number of individuals worldwide with high blood pressure at all ages is also expected to rise from 25% to 29% by 2025.3 However, the lifetime risk of developing high blood pressure is estimated to be greater than 90% in the US and probably true for most other countries.
  • A recent study showed the prevalence of hypertension in young adults aged (24–32) 19% compared to self reported prevalence of 9-11%. This unexpectedly high prevalence of hypertension suggests high risk of high risk of cardiovascular disease among US young adults and warrants further scrutiny.4
  • The risk of cardiovascular disease in people with high blood pressure is markedly increased in people with other cardiovascular risk factors. In fact, the vast majority of heart attacks  in men (40%) and women (68%) occur in those with other risk factors such as diabetes and dyslipidemia.5
  • A diet high in sodium increases the risk of developing hypertension. It has been estimated that a universal reduction in dietary intake of sodium by about 1g of sodium a day, about 3g of salt, would lead to a 50% reduction in the number of people needing treatment for hypertension.
  • A recent meta-analysis of 61 studies indicate that a 10 mmHg reduction in systolic blood pressure (SBP) or a 5 mmHg reduction diastolic blood pressure (DBP) is associated with a 40% reduced risk of stroke death, and a 30% reduced risk of CAD  death.5 (See Treatment of Hypertension).
  • The 2020 goal of the American Heart Association is to improve the cardiovascular health of all Americans by 20%, while continuing to reduce deaths from CVD and stroke by 20%.
  • Two of the key metrics for ideal cardiovascular health are a BP of <120/80 mm Hg and sodium consumption of <1500 mg/d.

FAQ

Q. How common is diagnosis and treatment of high blood pressure?

A. Despite the ease of diagnosis and wide spread availability of very safe and effective medications,  only 2 of 3 people with hypertension are diagnosed and blood pressure is uncontrolled in the vast majority (90%) of treated patients.

The diagnosis, treatment and control of high blood pressure are even lower in developing countries.  Despite 900 million people in developing countries have high blood pressure, only 300 million are aware of the their condition, only 100 million receive treatment, and only 5% have it controlled. 1

Increasing high blood pressure screening to cover an additional 25% of a country’s population would reduce the CVD events and deaths up to 3%, according to new research involving 19 countries. The increased screening would also increase treatment among high-risk individuals by 10%. 1

Strategies to increase the screening for hypertension could lead to significant reductions in CVD deaths, at costs that are considered to be acceptable according to WHO recommendations. 1

Sources

1. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama. 2003;289(19):2560-2572.

2. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. May 3 2008;371(9623):1513-1518.

3. Enas  EA, Singh V, Gupta R, Patel R, et al. Recommendations of the Second Indo-US Health Summit for the prevention and control of cardiovascular disease among Asian Indians. Indian heart journal. 2009;61:265-74.

4. Nguyen QC, Tabor JW, Entzel PP, et al. Discordance in National Estimates of Hypertension Among Young Adults. Epidemiology. Jul 2011;22(4):532-541.

5. Turnbull F., Pascal Kengne A, MacMahon S. Blood pressure and cardiovascular disease: tracing the steps from Framingham. Prog Cardiovasc Dis. Jul-Aug 2010;53(1):39-44.

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