Scope of Problem and Risks

Hypertension is the most common primary diagnosis at physician office visits in the United States each year. Approximately 50 million Americans have hypertension and approximately 30% are unaware of their problem. The prevalence is higher in African-Americans and in older patients. National Health and Nutritional Examination Surveys (NHANES) data suggest that hypertension is responsible for approximately one-third of heart attacks, one-half of heart failure, and one-fourth of premature deaths. Most patients with end-stage kidney disease are hypertensive. Hypertensive nephrosclerosis is responsible for approximately one-fourth of end-stage kidney disease. The risk of complications is directly related to the elevation of the blood pressure—the higher the blood pressure, the higher the risk.

Elevated systolic blood pressure is a greater risk for cardiovascular disease complications than elevated diastolic pressure. Control of systolic blood pressure tends to be more difficult to achieve, and when it is achieved, the diastolic blood pressure usually comes under control as well. The goal of treatment is to get the blood pressure to <140/90 mm Hg. For persons with diabetes or kidney disease, the goal is to achieve a blood pressure of <130/80 mm Hg.

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