Risk factors of hypertension
Hypertension, an increasingly common and chronic disease, and its consequences like stroke, coronary heart disease, heart failure and renal damage mean an enormous financial burden for the community. The risk of cardiovascular morbidity and mortality is proportional to the degree of systolic or diastolic blood pressure elevation at any age and in either sex, and is markedly influenced by risk factors commonly associated with BP elevation.
The term “isolated systolic hypertension” (ISH) describes raised systolic blood pressure with normal or low diastolic blood pressure. Some guidelines recognise two grades of isolated systolic hypertension:1,3
Increasingly, attention is becoming focused on systolic, rather than diastolic, blood pressure as the major factor to control in patients older than 50 years with essential hypertension.1,2 Elevated systolic blood pressure (SBP) is a powerful predictor of all-cause mortality, coronary artery disease, stroke and renal disease.4
Diagnostic procedures are aimed at: establishing blood pressure levels; identifying secondary causes of hypertension; evaluating the overall cardiovascular risk.
It is now widely recognised that elevated blood pressure is frequently associated with obesity, insulin resistance and dyslipidaemia. The clustering of these symptoms has given rise to the concept of the ‘metabolic syndrome’, which carries a high risk of diabetes and cardiovascular disease.
Guidelines for hypertension
Guidelines on modern management of hypertension reflect a more preventive approach with reduced target BP and risk factor evaluation. Initiation of antihypertensive treatment is based on two criteria; total level of cardiovascular risk and level of systolic and diastolic BP.
Lifestyle inverventions should be instituted whenever appropriate in all patients. Pharmacological therapy should be started gradually, and target BP achieved progressively. To reach target BP, a large proportion of patients will require combination therapy.
1. Williams B, Poulter NR, Brown MJ, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004 - BHS IV. J Hum Hypertens 2004;18:139-185
2. 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;289:2560-2572
3. ESH Guidelines Committee. 2003 European Society of Hypertension – European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003;21(6):1011-1053
4. Brooks DP, Ruffolo RR. Pharmacological mechanism of angiotensin II receptor antagonists: implications for the treatment of elevated systolic blood pressure. J Hypertens 1999;17(Suppl 2):S27-S32