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Chapter Summary

This chapter reviews the epidemiology, pathophysiology, diagnosis, and treatment of hypertension. The worldwide prevalence of hypertension is increasing with an aging population and increased prevalence of overweight and obesity. Hypertension is one of the strongest risk factors for cardiovascular diseases (myocardial infarction, heart failure, atrial fibrillation, and stroke), kidney disease, dementia, and overall mortality. Modifiable risk factors for hypertension include poor diet, excessive sodium intake, reduced physical activity, excessive weight gain, and alcohol intake (see Fuster and Hurst’s Central Illustration). Strategies focused on lifestyle modifications provide the cornerstone for the treatment and prevention of hypertension, although medications are often required to control blood pressure adequately. Effective control of blood pressure clearly reduces the risk for cardiovascular, kidney and brain disease, and death. Despite the availability of effective and inexpensive medications to control blood pressure, worldwide hypertension control continues to be unsatisfactory, with control rates in the United States <50% and as low as 8% to 14% in low- and middle-income countries. Unrecognized hypertension, patient nonadherence, and clinician inertia perpetuate this problem. Recent clinical trials indicate that blood pressure targets should be even lower than recommended in previous hypertension guidelines for more effective reduction of cardiovascular disease risk. Patient engagement in the treatment plan, home blood pressure monitoring (HBPM), and telehealth strategies may help improve hypertension control rates.

eFig 5-01 Chapter 5: Epidemiology, Pathophysiology, and Treatment of Hypertension


BP Classification and Diagnosis of Hypertension

Normal Blood Pressure

Normal blood pressure (BP) in adults is defined as a systolic blood pressure (SBP) of <120 mmHg and a diastolic blood pressure (DBP) of <80 mmHg (Table 5–1).1 Accurate measurement of BP and averaging of the readings (≥2 readings on ≥2 occasions) are essential for proper categorization of an individual’s BP.1 In childhood, BP starts at lower levels and gradually rises in the adolescent years. Until the age of 13 years, BP is categorized by age-adjusted percentiles. Normal BP is classified as less than the 90th percentile for children aged 1–12 years and as <120/80 mmHg in those ≥13 years of age.2

TABLE 5–1.Guideline Recommendations for BP Classification in Adults and Children

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