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Treating multiple-risk hypertensive populations
1Vascular Biology and Hypertension Program, University of Alabama-Birmingham, 35294, USA. soparil@uab.edu
Insights
Aggressively controlling high blood pressure (hypertension) in patients with multiple risk factors, including the elderly and those with diabetes, significantly reduces cardiovascular and renal disease risks. Lowering blood pressure is crucial for preventing serious health complications.
Area of Science:
- Cardiology
- Nephrology
- Geriatrics
- Endocrinology
Background:
- Most hypertension patients have additional cardiovascular disease risk factors.
- Identifying and stratifying risk in hypertensive patients is crucial for treatment planning.
- Elderly patients, those with diabetes, and individuals with target-organ damage are at higher risk.
Purpose of the Study:
- To highlight the importance of risk stratification in hypertension management.
- To emphasize the benefits of aggressive blood pressure control in high-risk populations.
- To underscore the need for lower blood pressure goals in specific patient groups.
Main Methods:
- Review of evidence supporting increased risk in elderly, diabetic, and renal-impaired hypertensive patients.
- Analysis of clinical trial results demonstrating benefits of aggressive blood pressure control.
- Examination of trends in hypertension, aging, diabetes, and end-stage renal disease.
Main Results:
- Isolated systolic hypertension (ISH) is prevalent in the elderly and associated with significant morbidity/mortality.
- Type 2 diabetes increases risk for coronary heart disease, stroke, and renal failure.
- Aggressive blood pressure control dramatically decreases cardiovascular complications in diabetic patients.
- Poorly controlled hypertension is a major contributor to increased end-stage renal disease.
- Lowering blood pressure below traditional goals is necessary to slow renal dysfunction.
Conclusions:
- Aggressive hypertension management in multiple-risk populations significantly reduces stroke, heart failure, coronary heart disease, and renal failure.
- Lowering blood pressure to recommended goals (e.g., JNC VI, WHO-ISH) is essential for preventing cardiovascular and renal complications.
- Hypertension treatment should be tailored to individual risk factors, especially in the elderly and diabetic populations.
Abstract:
The majority of patients with hypertension have one or more additional risk factors for cardiovascular disease. In planning an appropriate treatment program, it is useful to identify and stratify hypertensive patients according to their risk of developing cardiovascular, cerebrovascular, or renal disease. At particular risk are the elderly, patients with diabetes, and those with target-organ damage manifested by impaired renal function. Evidence supports increased risk in these patients, and clinical trial results demonstrate the considerable benefits realized through aggressive blood pressure (BP) control. The number of elderly individuals continues to increase in the United States and other industrialized countries. The prevalence of isolated systolic hypertension (ISH) is higher in the elderly than in younger individuals. ISH is associated with significant morbidity and mortality and should not be considered a physiologic manifestation of the normal aging process. Type 2 diabetes is also increasing in prevalence. Patients with diabetes are at increased risk for coronary heart disease, stroke, renal failure, and other cardiovascular complications. Aggressive treatment of elevated BP can produce dramatic decreases in the cardiovascular complications of diabetes. The incidence of end-stage renal disease has increased 2.5-fold in the past two decades, and poorly controlled BP is a major contributor to the increase. Lowering BP to levels well below the traditional goal of 140/90 mm Hg is needed to slow the progression of renal dysfunction and prevent renal failure in hypertensive patients with renal disease, whether related to diabetes or to another etiology. Aggressive treatment of hypertension in multiple-risk populations (to the goals of JNC VI and the recent WHO-ISH Guidelines for the Management of Hypertension) can be expected to produce significant reductions in the incidence and prevalence of stroke, heart failure, coronary heart disease, chronic renal failure, and total cardiovascular mortality.