CE REVIEW UNDERSTANDING HYPERTENSION

Hypertension is a chronic medical condition affecting more than 65 million Americans. Controlling hypertension is essential to decreasing the prevalence of cardiovascular morbidity and mortality. Hypertension increases risk of acute myocardial infarction, cerebral vascular disease, chronic renal failure and heart failure.

UDERSTANDING HYPERTENSION Stages of hypertension is as follows: − Pre-Hypertension: SBP 120 to 139 mm Hg or DBP 80 to 89 mm Hg − Stage 1 Hypertension: SBP 140 to 159 mm Hg or DBP 90 to 99 mm Hg − Stage 2 Hypertension: SBP ≥ 160 mm Hg or DBP ≥ 100 mm Hg 3

UNDERSTANDING HYPERTENSION Lifestyle factors likely play a significant role in the genesis of hypertension within the American population. Diet can substantially contribute to an increase in blood pressure, primarily through the ingestion of high amounts of sodium, low amounts of potassium, or an overabundance of alcohol, as does tobacco dependence. American culture often promotes these detrimental choices through the increased availability and decreased cost of fast foods and processed foods.

UNDERSTANDING HYPERTENSION Long-term implications of untreated or undiagnosed hypertension include heart attack, stroke, coronary heart disease, heart failure, and renal failure. 1,7 Hypertension is the most common risk factor for cardiovascular morbidity and mortality and contributes to an estimated 7.1 million deaths per year. 3,9 Cardiovascular risk doubles with every 20/10 mm Hg rise in blood pressure over 115/75. 3 Controlling blood pressure can be highly beneficial in diminishing the risk of these cardiovascular events. Every 3 mm Hg drop in systolic blood pressure is estimated to provide a 5% decrease in coronary heart disease mortality and an 8% decrease in stroke mortality. 7 Starting at 115/75 mm Hg, cardiovascular risk doubles with each increment of 20/10 mm Hg throughout the blood pressure range and persons who are normotensive at

UNDERSTANDING HYPERTENSION Lifestyle modifications are typically chosen as the first-line treatment for hypertension. When used in combination, diet and exercise have shown notable improvements in blood pressure, often achieving adequate control or providing the opportunity for lower doses of medication. Nonpharmacologic treatments are particularly beneficial in the African-American population, which often presents with higher blood pressure than non–African-Americans. 7

UNDERSTANDING HYPERTENSION Pharmacologic treatment is necessary for many patients with hypertension. Over 75% of patients require 2 or more medications to achieve blood pressure goal. 3,10 A number of pharmacologic classes have been utilized for blood pressure control including thiazides, loop diuretics, aldosterone antagonists, ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, alpha-1 adrenoreceptor antagonists, central alpha-2 adrenoreceptor agonists, and direct vasodilators. 3 Please refer to Table 1 for a list of examples of specific medications and their respective pharmacotherapeutic class and dosing range.Table 1

UNDERSTANDING HYPERTENSION Compelling IndicationRecommended Medications Heart FailureLoop diuretic Beta-blocker ACE Inhibitor ARB Aldosterone Antagonist Postmyocardial InfarctionBeta-blocker ACE Inhibitor Aldosterone Antagonist High Coronary Disease RiskDiuretic Beta-blocker ACE Inhibitor Calcium Channel Blocker DiabetesBeta-blocker ACE Inhibitor ARB Calcium Channel Blocker Chronic Kidney DiseaseACE Inhibitor ARB Recurrent Stroke PreventionDiuretic ACE Inhibitor ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blocker