25. REF: JNC -7 (THE 7 TH REPORT OF JOINT NATIONAL COMMITTEE ON PREVENTION, DETECTION, EVALUATION AND TREATMENT OF HIGH BLOOD PRESSURE) PAGE 27, 28,29
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44. Approximately 50 Million Americans Have Hypertension Uncontrolled 72.6% Controlled 27.4% 13.7 million 36 million
45. Global Mortality 2000: Impact of Hypertension and Other Health Risk Factors Ezzati et al. Lancet. 2002;360:1347-1360. Attributable Mortality (In thousands; total 55,861,000) 0 8000 7000 6000 5000 4000 3000 2000 1000 High blood pressure Tobacco High cholesterol Unsafe sex High BMI Physical inactivity Alcohol Indoor smoke from solid fuels Iron deficiency Underweight High mortality, developing region Lower mortality, developing region Developed region
46. Complications of Hypertension : TIA = transient ischemic attack; LVH = left ventricular hypertrophy; CHD = coronary heart disease; HF = heart failure. Cushman WC. J Clin Hypertens. 2003;5(Suppl):14-22. Hypertension is a risk factor Retinopathy Renal failure Peripheral vascular disease LVH, HF,CHD, TIA, stroke
02/16/10 The Comparative Risk Assessment module of the World Health Organization (WHO)’s Global Burden of Disease 2000 study performed a systematic assessment of changes in population health that would result from modifying exposure to environmental and physiological health risk factors. The methodology used to determine the attributable mortality and attributable burden of disease due to each risk factor was a counterfactual analysis in which the contribution of 1 or a group of risk factors is estimated by comparing the current disease burden with the magnitude that would be expected in an alternative scenario characterized by a theoretical minimal exposure. In the case of high BP and cholesterol, the theoretical minimal exposures were levels of 115 mm Hg and 3.8 mmol/L, respectively. This analysis of the contribution of 26 selected risk factors to global disease burden found that high BP was the leading cause of mortality in both developing regions and developed regions of the world. The study looked at the impact of risk factors on mortality. High mortality, developing regions such as many countries in Africa and Southeast Asia. Lower mortality, developing regions such as Latin America and countries in the Western Pacific. Developed regions including Europe, Japan, and North America. In high mortality, developing regions, the leading causes of death were reported to be childhood and maternal undernutrition, including being underweight. However, despite the large contribution of communicable, maternal, perinatal, and nutritional conditions and their underlying risk factors to disease burden in the high mortality, developing regions, the “industrialized” risks of high BP, tobacco, and blood cholesterol levels also resulted in significant loss of life in these regions. Across developed regions, high BP, tobacco use, alcohol, high cholesterol, and high body mass index (BMI) were reported to be consistently the leading causes of loss of life. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJL, and the Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347-1360. SLIDE
02/16/10 Hypertension is an important contributing risk factor for end-organ damage and subsequent increases in morbidity and mortality. The goal in treating hypertension is to prevent cardiovascular and renal complications. Even small elevations above optimal blood pressure (BP) values (<120/80 mm Hg) increase the likelihood of developing hypertension (BP ≥140/90 mm Hg) and incurring target-organ damage. Chronic elevations of BP lead to target-organ damage and the development of cardiovascular and renal diseases, including retinopathy, peripheral vascular disease, stroke, coronary heart disease, heart failure, left-ventricular hypertrophy, and renal failure. Signs of target-organ damage herald a poorer prognosis and may present in the heart, blood vessels, kidneys, brain, or eyes. Later consequences include cardiac, cerebrovascular, vascular, and renal morbidities and death. Because of the complex nature of hypertension, it is not surprising that single antihypertensive agents normalize BP for less than a majority of hypertensive patients. Reference Cushman WC. J Clin Hypertens . 2003;5(suppl):14-22.
02/16/10
02/16/10 In summary, the key messages regarding BP targets for clinicians treating patients with diabetes and hypertension are as follows: SBP is a far more important target than DBP for both CV and renal protection; it is a particularly crucial modulator of risk in older patients and those with diabetes or CKD. Clinicians should focus on reducing SBP to currently recommended levels—<140 mm Hg in all patients with hypertension; <130 mm Hg in higher risk patients, such as those with diabetes and/or CKD. Only a small fraction of treated hypertensives are currently achieving appropriate BP control based on data from national surveys. The failure to achieve intensive BP targets results in less than maximum benefit to these patients. Patients with diabetes, especially those with renal impairment, usually require at least 2 different antihypertensive agents to achieve goal BP; many require at least 3 agents.
Although heart catheterization remains the “gold standard” for the diagnosis of coronary artery disease ….
