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The burden of uncontrolled hypertension: morbidity and mortality associated with disease progression

William C Cushman1

  • 1Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, TN 38104, USA. wcushman@pol.net

Journal of Clinical Hypertension (Greenwich, Conn.)
|June 27, 2003
PubMed

Insights

Elevated blood pressure increases hypertension risk and organ damage. Combination therapy effectively lowers blood pressure and protects against target organ damage by addressing multiple pathological mechanisms.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Endocrinology

Background:

  • Even minor elevations above optimal blood pressure (<120/80 mm Hg) elevate hypertension risk (>or=140/90 mm Hg) and target organ damage.
  • Historically, diastolic pressure was the focus; however, systolic hypertension, pulse pressure, and nocturnal blood pressure changes are now recognized as critical.
  • Primary hypertension results from complex genetic, environmental, metabolic, vascular, and endothelial factors.

Purpose of the Study:

  • To highlight the multifaceted nature of hypertension and its management.
  • To emphasize the importance of comprehensive treatment strategies beyond solely lowering diastolic blood pressure.
  • To underscore the benefits of combination therapy in achieving blood pressure goals and preventing complications.

Main Methods:

  • Review of current understanding of hypertension pathophysiology.
  • Analysis of treatment strategies, including lifestyle interventions and pharmacotherapy.
  • Evaluation of the role of systolic pressure, pulse pressure, and nocturnal blood pressure patterns.

Main Results:

  • Hypertension is linked to target organ damage in the heart, kidneys, brain, and eyes, leading to poorer prognosis.
  • Intensive lifestyle interventions are beneficial for patients with high-normal blood pressure, especially those with cardiovascular risk factors.
  • Combination antihypertensive therapy, using multiple drug classes, improves blood pressure normalization rates and offers enhanced protection against target organ damage.

Conclusions:

  • Hypertension management requires addressing its complex etiology and diverse contributing factors.
  • Combination antihypertensive therapy is often necessary to achieve target blood pressure goals and mitigate cardiovascular and renal complications.
  • Targeting separate pathological mechanisms through combination therapy provides superior protection against target organ damage compared to monotherapy.

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