Hypertensive Therapy: Part I

Cardiovascular disease (CVD), including stroke, is themost common cause of death and disability in developed countries, and hypertension is one of the most important modifiable risk factors for these outcomes.1 The relationship between blood pressure (BP) and CVD mortality is positive, strong, continuous, graded, and predictive, for those with or without coronary heart disease, and it increases with age.2,3 A meta-analysis of observational studies involving more than 1 million individuals without prior histories of stroke or heart disease carried out by the Prospective Studies Trialists’ Collaboration demonstrated that death from coronary heart disease and stroke increases continuously and linearly from BP levels as low as 115 mm Hg systolic and 75 mm Hg diastolic.3 An increment of 20 mm Hg in systolic BP (SBP) or 10 mm Hg in diastolic BP (DBP) in middle-aged and elderly persons is associated with a 2-fold increase in cardiovascular (coronary heart disease and stroke) mortality throughout the entire range of BP (Figure 1). In addition, data from the Framingham Heart Study showed that, when compared with “optimum ” BP (SBP 120 mm Hg and DBP 80 mm Hg), “normal ” BP (SBP 120 to 129 mm Hg or DBP 80 to 84 mm Hg) is associated with a 2- to 4-fold increase in risk of developing hypertension, and “high normal ” BP (SBP 130 to 139 mm Hg or DBP 85 to 89 mm Hg) is associated with a 5-fold increased risk.4 Hypertension, defined as SBP 140 mm Hg or DBP 90 mm Hg or the use of antihypertensive medications, is a major public health problem, affecting almost 29 % of the adult US population, according to the US National Health and Nutrition Examination Survey (NHANES),5 and 44 % of the population in Europe.6 Importantly, there has been an in-crease in the prevalence of hypertension in the United States