Hypertension

Abstract

November 2006

Section 1 Cardiovascular Medicine

III Hypertension

Gary L. Schwartz, M.D., F.A.C.P.
Associate Professor of Medicine, Mayo Medical School; Chair, Division of Hypertension, Mayo Clinic

Sheldon G. Sheps, M.D., F.A.C.P.
Emeritus Professor of Medicine Mayo Medical School

Hypertension is the most common chronic disorder in the United States. The prevalence increases with age: for a normotensive middle-aged person in the United States, the lifetime risk of developing hypertension approaches 90%. With the increasing age of the population in most developed and developing societies, it seems safe to assume that hypertension will become steadily more widespread in the coming years. Hypertension is a major risk factor for stroke, myocardial infarction, heart failure, chronic kidney disease, progressive atherosclerosis, and dementia. The treatment of hypertension is highly effective in reducing cardiovascular morbidity and mortality. However, despite widespread public and professional education regarding the risks of hypertension and the benefits of treatment, and despite the ready availability of effective therapies, only 58% of adults with hypertension are on treatment, and in only 31% of hypertension patients is the hypertension controlled. This chapter presents a definition of hypertension and prehypertension and reviews their etiology, pathogenesis, and diagnosis. Secondary hypertension is described, including renovascular disease, primary aldosteronism, pheochromocytoma, Cushing syndrome, and coarctation of the aorta. The two most common treatments for essential hypertension—lifestyle modification and antihypertensive medication—are discussed. Reasons for resistance to treatment, including white-coat hypertension and pseudohypertension, are described, as are treatments for specific groups, including patients with isolated systolic hypertension or hypertensive crisis, elderly patients, and patients with diabetes, heart disease, chronic kidney disease, or acute stroke. A figure illustrates the drug treatment for essential hypertension. Tables present information on the diagnosis and treatment of essential hypertension, secondary hypertension, and hypertensive crisis. This chapter contains 149 references.

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