Getting To Goal: Effective Control Of Hypertension
Roger S. Blumenthal, MD
Diseases related to hypertension currently affect millions of Americans, at an annual cost exceeding $50 billion. This issue of Advanced Studies in Medicine is dedicated to supporting and promoting effective detection, prevention, and treatment of hypertension and reducing the societal cost of this potentially devastating but widely underdiagnosed and undertreated condition. Information presented here supports and reinforces ongoing national efforts to reduce human and economic costs associated with hypertension and profiles current recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), which offer a practical plan for improving hypertension detection and treatment in any practice setting.
In this monograph, Dr Joseph L. Izzo, Jr, briefly reviews the pathophysiology of hypertension and describes the stroke and vascular disease mortality reductions that can be achieved among patients who reach the JNC-7Ðdesignated blood pressure target of less than 140/90 mm Hg, or less than 130/80 mm Hg for those patients with diabetes or chronic kidney conditions. Dr Izzo summarizes new recommendations evident in the JNC-7 guidelines, reviews available drug treatment options, and offers useful caveats regarding agent selection. He also discusses treatment with particular therapeutic agents as considerations for patients with compelling indications for diabetes mellitus, chronic kidney disease, cardiac failure, coronary heart disease/high coronary risk, or recurrent stroke.
Treatment of patients at high risk for hypertension is further elaborated in my article, in which I discuss agent selection for patients with concurrent conditions, such as heart disease or diabetes mellitus. I present a treatment algorithm from the JNC-7 guidelines, which incorporate new recommendations and key messages for comprehensive treatment of primary hypertension and discuss the essential lifestyle modifications that continue to be important for all patients with hypertension. I also present important issues related to selecting first-line treatment, which is often a combination therapy approach in patients more than 20 mm Hg above their systolic and more than 10 mm Hg above their diastolic blood pressure targets.
Dr C. Venkata S. Ram discusses public health implications of hypertension, including the proven role of improved blood pressure control in reducing cardiac risk and preventing or delaying chronic kidney disease. Dr Ram also presents significant public health opportunities for the prevention of hypertension, shares important advice about treatment-related quality-of-life concerns, and includes useful suggestions for patient compliance improvement and treatment cost reduction. The epidemiology of hypertension, a challenging problem that currently is widespread in American society, is presented and discussed throughout the monograph.
*Associate Professor of Medicine, Department of MedicineÐ Cardiovascular, Johns Hopkins Ciccarone Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Address correspondence to: Roger S. Blumenthal, MD, Associate Professor of Medicine, Department of MedicineÐ Cardiovascular, Johns Hopkins Ciccarone Center, Johns Hopkins University School of Medicine, 600 North Wolfe StreetÐBlalock 524 C, Baltimore, MD 21287.