Chapter 5: Epidemiology, Pathophysiology, and Treatment of Hypertension

Content Update

Phase 2 KARDIA-2 Trial

The KARDIA-2 trial was a global, multicenter, phase 2, randomized, double-blind, placebo-controlled study designed to evaluate the safety and efficacy of zilebesiran compared with placebo among patients with uncontrolled hypertension. Zilebesiran is an investigational, biannually dosed, subcutaneously injected RNA interference agent that blocks production of angiotensinogen. Read More

Content Update

Sustained Blood Pressure Reduction With the RNA Interference Therapeutic Zilebesiran: Primary Results From KARDIA-1, a Phase 2 Study in Patients With Hypertension

The KARDIA-1 trial was a randomized, blinded, phase 2 study of zilebesiran, an investigational long-acting RNA interference agent that inhibits hepatic angiotensinogen synthesis by reducing liver angiotensinogen mRNA levels. Read More

Content Update

DANCAVAS: Five-Year Outcomes of the Danish Cardiovascular Screening Trial

The DANCAVAS (Danish Cardiovascular Screening) trial was designed to assess the impact of population-based cardiovascular health screening with respect to the risk of death. Read More

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.