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Hypertension: where have we gone wrong and how can we fix it?
1Orange County Heart Institute and Research Center, Orange, California 92868, USA.
Insights
Hypertension is more than just high blood pressure; it is a complex syndrome of inherited cardiovascular risk factors. Early diagnosis and syndrome-based treatment are crucial for better management of hypertension and coronary artery disease.
Area of Science:
- Cardiology
- Genetics
- Internal Medicine
Background:
- Hypertension is traditionally defined by elevated blood pressure, with treatment goals focused on normalization.
- Despite effective blood pressure control, expected reductions in coronary artery disease (CAD) incidence have not been achieved.
- This discrepancy necessitates a re-evaluation of hypertension's role in CAD development.
Purpose of the Study:
- To investigate if hypertension encompasses more than elevated blood pressure.
- To explore the concept of hypertension as a complex inherited syndrome of cardiovascular risk factors.
- To understand the implications for diagnosing and managing hypertension.
Main Methods:
- Review of existing research and clinical findings on hypertension and coronary artery disease.
- Analysis of the components of the 'hypertension syndrome'.
- Comparison of 'number-based' versus 'syndrome-based' management approaches.
Main Results:
- Hypertension is increasingly recognized as a syndrome, not just high blood pressure.
- Associated risk factors include lipid abnormalities, insulin resistance, renal and endocrine changes, obesity, coagulation disorders, left ventricular hypertrophy, and vascular dysfunction.
- Elevated blood pressure may be a late manifestation of this underlying syndrome.
Conclusions:
- Effective hypertension management requires viewing it as a complex syndrome with multiple contributing factors.
- Early diagnosis and treatment targeting the entire syndrome, not just blood pressure numbers, are essential.
- This paradigm shift may improve outcomes in patients with hypertension and reduce coronary artery disease incidence.
Abstract:
Hypertension is defined as a disease of elevated systolic and diastolic blood pressure and consequently the goals of treating hypertension have been simply to normalize the blood pressure. However, effective blood pressure control has not resulted in the expected decreases in coronary artery disease. These findings have forced researchers to reexamine the importance of blood pressure in causing coronary artery disease, and to pose the question "Is there more to hypertension than high blood pressure?" Although there are probably several reasons for the poor reduction in the incidence of coronary artery disease in hypertensive patients, one of the most compelling appears to be the realization that hypertension is not simply a disease of numbers, but is a complex inherited syndrome of cardiovascular risk factors, all of which contribute to heart disease in these patients. Included in the hypertension syndrome are abnormalities of lipid profile, insulin resistance, changes in renal function, endocrine changes, obesity, abnormalities of coagulation factors, left ventricular hypertrophy and diastolic dysfunction, and abnormalities of vascular structure and compliance. In many patients, high blood pressure is a late manifestation of this disease process and is preceded by some or all of the associated cardiovascular risk factors. Perhaps where we have gone wrong in the management of hypertension is in the belief that this is simply a disease of numbers. To improve our management, we need to find methods to diagnose these patients early in the course of this disease process, and to treat it as a syndrome rather than as a number.