The Treatment of Adults with Essential Hypertension

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Applied Evidence

The Treatment of Adults with Essential Hypertension

J Fam Pract. 2002 January;51(1):74-80

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References

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Patients willing to regularly monitor their blood pressure at home may require less frequent follow-up than those who leave it to the physician to check. Patients who monitor their blood pressure at home should have their sphygmomanometers validated initially and periodically.⁴⁴ It is important to remember that home blood pressure measurements are consistently lower and more closely correlated with cardiovascular outcomes than are clinic blood pressure measurements.^45-47

Prognosis

It is difficult to estimate the precise impact blood pressure control has on morbidity and mortality, but it is clear that high blood pressure, if unrecognized or untreated, substantially increases the morbidity and mortality associated with coronary disease, heart failure, renal failure, and stroke.¹⁷ In an early study of untreated hypertension there was a close relationship between blood pressure level and cardiovascular morbidity over 14 years of observation. This study revealed that hypertensive patients (those with a blood pressure of 160/95) had cardiovascular morbidity rates (coronary artery disease, claudication, stroke, and congestive heart failure) 2 to 3 times higher than normotensive patients.⁴⁸ The impact of inadequately controlled blood pressure on morbidity and mortality among patients with diabetes is especially problematic.⁴⁹ Over 9 years, when compared with diabetic patients with less tight control (< 180/105 mm Hg), those with tight blood pressure control (< 150/85 mm Hg) had a 24% reduction in sudden death, hyperglycemic or hypoglycemic death, fatal or nonfatal myocardial infarction, angina, heart failure, fatal or nonfatal stroke, renal failure, amputation, vitreous hemorrhage, and retinal hemorrhage.

Finally, renal function deteriorates more rapidly when blood pressure control is inadequate in patients with chronic renal disease of diverse causes.²⁰ Over 2 years, when compared with patients with renal failure who had less tight control (mean arterial pressure 107 mm Hg), renal failure patients with tight control (mean arterial blood pressure 92 mm Hg) had significantly less proteinuria and lower rates of decline in renal function. Whether this translates into a significant improvement in the risk of end-stage renal disease is unknown.