Epidemiology of risk factors for hypertension: implications for prevention and therapy

We review the present knowledge of risk factors for arterial hypertension. Both genetic and environmental factors as well as their interaction and biological plausibility are reviewed. Recent data confirm that the interaction of genetics with multiple environmental risk factors explains the high prevalence of hypertension in the industrialised countries. The most important modifiable environmental risk factors are high salt intake, alcohol intake, obesity and low physical activity. The role of stress in the aetiology of high blood pressure is still under investigation, but recent clinical experimental and epidemiological data have shed light on how stress could be related to hypertension. The implications for prevention and treatment are discussed both at the population and individual levels. The population approach involves a public health policy aiming at modification of the major risk factors. The individual approach involves nonpharmacological measures to prevent the development of hypertension and to treat high normal blood pressure and mild hypertension with no additional cardiovascular risk factors. Pharmacological treatment of hypertension in most individuals should use agents that have been proven to be effective in randomised controlled trials with 'hard' endpoints such as cardiovascular and cerebrovascular morbidity and mortality.