Chronic hypertension natural history
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Hypertension Main page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Taylor Palmieri, Yazan Daaboul, Serge Korjian
Overview
Hypertension is a well-established risk factor for several serious diseases. Chronic uncontrolled hypertension can be complicated by target organ damage. Most common damaged organs include the cardiovascular system, the brain, the kidneys, and the retina. Even moderate elevation of arterial blood pressure leads to a shortened life expectancy. At severely high mean arterial pressures, 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.[1]
Complications
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Because patients with hypertension usually have other concomitant cardiovascular risk factors, such as dyslipidemia and diabetes mellitus, the isolated effect of hypertension on cardiovascular outcomes may be difficult to assess. However, the Framingham Heart study and other trials and observational studies well-established that hypertension has an additive effect, among other risk factors, in contribution to cardiovascular disease and events.[2][3][4][5] While some risk factors are directly induced by hypertension and its vascular effects, such as renal insufficiency, stroke, and heart failure, the mechanism of other complications, such as dyslipidemia, insulin resistance, and atherogenesis, is not as straightforward.[6] These complications are not only worsened by hypertension, but also may predispose to hypertension and together are risk factors for cardiovascular disease, events, and mortality.[6]
Almost half of deaths in the USA are attributed to cardiovascular diseases, such as coronary artery disease and stroke. Hypertension is considered a strong risk factor for the development of cardiovascular events in target organs, such as the heart, the brain, the kidneys and within the arterial system.[7] Even more recent data has shown that all-cause mortality risk for 11 years increases with higher SBP and DBP even in the non-hypertensive ranges: compared to men with SBP < 110 mmHg, those with SBP between 120 and 129 had a 1.16 risk of cardiovascular death. The risk increases gradually with increased blood pressure values to reach almost 1.6 times when SBP is only between 140 and 149 mmHg. The risk exceeds two-folds when SBP is > 150 mmHg and exceeds 3-folds when SBP>180 mmHg.[8] The risk of diastolic blood pressures is also significantly associated with cardiovascular disease and death.[8] While higher SBP and DBP have been found to be risk factors for cardiovascular disease, too much lowering of both SBP and DBP is currently under further investigation with the recent introduction of the J-curve phenomenon, defined as increased risk at very high an very low systolic and diastolic blood pressures.[9][10] Whether very low diastolic blood pressures are a cardiovascular risk per se or due to their association with an increased systolic blood pressure and high pulse pressure, the real mechanism is poorly understood.[11][12][9]
When followed for 10 years, patients with hypertension had a 20% risk of fatal and non-fatal cardiovascular events.[13][14] Newer studies confirm similar findings for non-hypertensive patients who are older than 65 years and fall in the high-normal blood pressure category.[2]
References
- ↑ Textbook of Medical Physiology, 7th Ed., Guyton & Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.
- ↑ 2.0 2.1 Vasan RS, Larson MG, Leip EP, Evans JC, O'Donnell CJ, Kannel WB; et al. (2001). "Impact of high-normal blood pressure on the risk of cardiovascular disease". N Engl J Med. 345 (18): 1291–7. doi:10.1056/NEJMoa003417. PMID 11794147.
- ↑ Lowe LP, Greenland P, Ruth KJ, Dyer AR, Stamler R, Stamler J (1998). "Impact of major cardiovascular disease risk factors, particularly in combination, on 22-year mortality in women and men". Arch Intern Med. 158 (18): 2007–14. PMID 9778200.
- ↑ Kannel WB (1996). "Blood pressure as a cardiovascular risk factor: prevention and treatment". JAMA. 275 (20): 1571–6. PMID 8622248.
- ↑ Frohlich ED (2009). "Hypertensive disease: current challenges, new concepts and management. Preface". Med Clin North Am. 93 (3): xv–xx. doi:10.1016/j.mcna.2009.02.016. PMID 19427488.
- ↑ 6.0 6.1 Kannel WB (2009). "Hypertension: reflections on risks and prognostication". Med Clin North Am. 93 (3): 541–58, Table of Contents. doi:10.1016/j.mcna.2009.02.006. PMC 3719976. PMID 19427490.
- ↑ Murabito JM, D'Agostino RB, Silbershatz H, Wilson WF (1997). "Intermittent claudication. A risk profile from The Framingham Heart Study". Circulation. 96 (1): 44–9. PMID 9236415.
- ↑ 8.0 8.1 Stamler J, Stamler R, Neaton JD (1993). "Blood pressure, systolic and diastolic, and cardiovascular risks. US population data". Arch Intern Med. 153 (5): 598–615. PMID 8439223.
- ↑ 9.0 9.1 Peters R, Beckett N, Fagard R, Thijs L, Wang JG, Forette F; et al. (2013). "Increased pulse pressure linked to dementia: further results from the Hypertension in the Very Elderly Trial - HYVET". J Hypertens. 31 (9): 1868–75. doi:10.1097/HJH.0b013e3283622cc6. PMID 23743809.
- ↑ Bangalore S, Messerli FH, Wun CC, Zuckerman AL, DeMicco D, Kostis JB; et al. (2010). "J-curve revisited: An analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial". Eur Heart J. 31 (23): 2897–908. doi:10.1093/eurheartj/ehq328. PMID 20846991.
- ↑ Kannel WB, Wilson PW, Nam BH, D'Agostino RB, Li J (2004). "A likely explanation for the J-curve of blood pressure cardiovascular risk". Am J Cardiol. 94 (3): 380–4. doi:10.1016/j.amjcard.2004.04.043. PMID 15276113.
- ↑ Cruickshank JM, Thorp JM, Zacharias FJ (1987). "Benefits and potential harm of lowering high blood pressure". Lancet. 1 (8533): 581–4. PMID 2881129.
- ↑ "1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee". J Hypertens. 17 (2): 151–83. 1999. PMID 10067786.
- ↑ Wood D, De Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K (1998). "Prevention of coronary heart disease in clinical practice. Summary of recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention". J Hypertens. 16 (10): 1407–14. PMID 9814610.