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INTRODUCTION

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Hypertension, elevated systemic arterial pressure, is a recognized risk factor and cause of fatal and nonfatal cardiovascular and renal disease that has become a public health problem worldwide.1,2 Furthermore, treatment of hypertension with widely available antihypertensive drugs is highly effective for long-term prevention of cardiovascular disease as demonstrated in well-controlled randomized clinical trials.3 On a global basis, it has been predicted that treating hypertension will have the greatest impact over the next decade in preventing premature cardiovascular mortality.4

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BLOOD PRESSURE CLASSIFICATION

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The diagnosis of hypertension has, in the past, been based on measurements in the office or clinic. Clinic blood pressures have been the basis for assessing response to treatment in the large randomized clinical trials that have provided the evidence for establishing the effectiveness of antihypertensive drug treatment. However, the development of technologies for accurate measurement of arterial pressure outside the clinic and during usual activity through 24-ambulatory blood pressure monitoring and home blood pressure assessment has led to expansion of the terms used to define hypertension. Table 25–1 provides current classification of hypertensive disorders as recommended in recent guidelines.

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TABLE 25–1.Glossary: Classification of Hypertension in Adult Patients
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Based on clinic measurements alone, patients may be classified by the height of the pressure: optimal or normal pressure, prehypertension overlapping with high-normal pressure, and definite hypertension. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) further subdivided definite hypertension into stage I, 140–159/90–99 mm Hg, and stage II, more than 160/100 mm Hg.5 The panel report for JNC 8 suggested that, for older patients, a cutoff of 150 mm Hg systolic pressure was more consistent with evidence from clinical trials.6 This conclusion has been questioned and remains controversial.7 However, results from two recently conducted studies, Systolic Blood Pressure Intervention Trial (SPRINT) ...

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