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Risk factors in hypertension
1Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Massachusetts 02118.
Insights
Hypertension significantly raises cardiovascular risks like atherosclerosis and coronary disease. Managing associated factors alongside blood pressure is crucial for optimal treatment and preventing serious events.
Area of Science:
- Cardiology
- Public Health
Background:
- Hypertension is a major contributor to cardiovascular morbidity and mortality.
- Atherosclerosis and coronary heart disease are primary hazards associated with elevated blood pressure.
Purpose of the Study:
- To emphasize the critical role of associated risk factors in hypertension management.
- To highlight the dangers of delaying treatment until organ involvement is evident.
Main Methods:
- Analysis of cardiovascular risk factors in hypertensive patients.
- Evaluation of the impact of combined risk factors on cardiovascular outcomes.
- Assessment of electrocardiogram-left ventricular hypertrophy (ECG-LVH) as a predictor of cardiovascular events.
Main Results:
- Cardiovascular risk is proportional to blood pressure elevation and significantly influenced by associated factors.
- Hypertensive individuals with high total/HDL-cholesterol ratio, impaired glucose tolerance, high fibrinogen, ECG abnormalities, and smoking face concentrated coronary heart disease risk.
- ECG-LVH is a strong predictor of sudden death, infarction, cardiac failure, and stroke.
Conclusions:
- Comprehensive assessment of cardiovascular risk factors is essential for effective hypertension treatment, goal setting, and efficacy determination.
- Optimal hypertension management requires addressing the composite risk profile, not just blood pressure.
- Early intervention is vital, as the first sign of organ involvement can be a fatal cardiovascular event.
Abstract:
Hypertension increases cardiovascular morbidity and mortality two- to fourfold. The chief hazards are now atherosclerosis and coronary disease. Risk is proportional to the degree of systolic or diastolic blood pressure elevation at any age, in either sex. More than the character of blood pressure elevation, commonly associated risk factors markedly influence the hazard. The risk of coronary heart disease is concentrated in hypertensive patients with a high total/high-density lipoprotein (HDL)-cholesterol ratio, impaired glucose tolerance, high fibrinogen, electrocardiographic (ECG) abnormalities, and who are cigarette smokers. Evidence of organ involvement such as left ventricular function are hallmarks of impending cardiovascular sequelae. Electrocardiogram-left ventricular hypertrophy (ECG-LVH) behaves like myocardial infarction in its clinical course, predisposing at the same rate to sudden death, infarction, cardiac failure, and stroke. Consideration of cardiovascular risk factors is required to evaluate properly the need for treatment, select the best treatment, set goals, and determine the efficacy of treatment. Awaiting evidence of organ involvement is dangerous since the first such evidence is often a sudden death, stroke, or myocardial infarction. Optimal treatment must improve the composite risk profile as well as lower the blood pressure.