Review Of Literature Of Hypertension
The guidelines are instead selecting patients assumed to be at highest risk.
Patients with severe hypertension (clinic reading ≥180/110mm Hg), those with confirmed stage II hypertension (on ABPM) and those less than 80 years with stage i hypertension and target organ damage established cardiovascular disease renal diabetes mellitus or a 10-year risk 20 should be treated.
It is incongruous that they should be fourth line for hypertension in patients with quiescent coronary artery disease, but then receive an upgrade to first line once coronary artery disease becomes overt, despite the fact that BP lowering is the most powerful way to control both primary and secondary risk.
There are suggestions that they might be less protective against stroke and might increase the rate of diabetes.
Furthermore, although ABPM and HBPM readings are better at predicting cardiovascular events than clinic readings, all of the studies demonstrating improved outcome from antihypertensive therapy have been based on a diagnosis made in a clinic setting. now fall outside diagnosis and treatment thresholds. It is difficult to reconcile this aim with recent data suggesting that patients throughout Europe, including the UK, are frequently undertreated or not treated at all. Hypertension is now one of the most common conditions treated in primary care in the UK.Although young adults with high BP are frequently referred for investigation to exclude high-profile but rare secondary causes (see box, below), most adult patients (95%) with high BP have primary hypertension.Measures are required at a Tulane University School of Medicine, New Orleans, Louisiana, USA.Sponsorship: This work was supported in part by grant R01HL68057 from the National Heart, Lung and Blood Institute of the National Institutes of Health, in Bethesda, Maryland, USA.A urine dipstick will identify proteinuria and haematuria, but in patients with diabetes mellitus or younger patients in whom secondary hypertension is suspected, a 24-hour urine collection for protein excretion or hormonal metabolites is useful. In most cases an ECG should also be performed to exclude arrhythmia, and to document baseline heart rate and the presence or absence of LVH. Hypertension risk factors Smoking, obesity and metabolic syndrome are causally associated with high BP and the combination of several or all of these risk factors in the UK population is increasingly common.Other risk factors for the development of hypertension include alcohol, family history and ethnic origin.