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Chapter 23: Epidemiology of Hypertension

A 48-year-old man presents in follow-up to your outpatient clinic. He has no comorbidities apart from right knee osteoarthritis and obesity. His blood pressure on his initial visit with you was 136/86 mm Hg. After losing 5 lb, today’s blood pressure is 132/80 mm Hg. This patient’s blood pressure can be labeled:

A. White coat hypertension

B. Benign hypertension

C. Isolated systolic hypertension

D. Prehypertension

E. Pseudohypertension

The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 23). The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) 7 classi­fication for hypertension has defined normal BP as < 120 and < 80 mm Hg. What JNC-6 previously labeled as normal (120–129 mm Hg systolic BP or 80–84 mm Hg diastolic BP) and high normal (130–139 mm Hg systolic BP or 85–89 mm Hg diastolic BP) are now combined into a single group called prehypertension (option D), to increase the awareness of people with an intermediate level of risk that they may progress to definite hypertension. White coat hypertension (or isolated office hypertension) (option A) is diagnosed in patients not on any BP-lowering medications when the BP is elevated only persistently in the presence of a health care worker, particularly a physician. Benign hypertension, which alluded to less severe forms of hypertension, is a misnomer and is no longer used (option B). When the average systolic BP is at least 140 mm Hg or more and diastolic BP is < 90 mm Hg, the patient is classified as isolated systolic hypertensive (option C). The term pseudohypertension (option E) refers to a falsely elevated diastolic BP when in fact it is low. This condition represents wide pulse pressure isolated systolic hypertension in the elderly and often occurs with diabetes and diabetic kidney disease; it is associated with extensive calcification of many large arteries, including the brachial and elastic aorta.

Which of the following statements about prehyper­tension is false?

A. The lifetime risk of hypertension approaches 50%, warranting the importance of recognizing the concept of prehypertension to promote lifestyle changes to prevent the onset of hypertension

B. In persons without cardiovascular disease or cancer, the prevalence of prehypertension is 36%, and it is higher in men than in women

C. Prehypertension is associated with abnormalities of cardiac structure and function

D. Approximately 15% of BP-related deaths from coronary heart disease occur in individuals with BP in the prehypertensive range

E. Persons with prehypertension have a 43% higher risk of incident coronary heart disease than those with optimal blood pressure (< 120/80 mm Hg)

The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 23). The lifetime risk of hypertension approaches 90%1 (not 50%), which emphasizes the need to recognize prehypertension to help motivate physicians and patients ...

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