Hypertension: diagnostic problem, challenge and dilemmas.

ABSTRACT

An elevated arterial pressure is probably the most important public health problem. The prevalence of hypertension depends on both the racial composition of the population studied and the criteria used to define the condition. Patients with hypertension die prematurely, the most common cause of death is heart disease, stroke, and renal failure. The JNC-7 report has introduced a new classification that includes term "pre-hypertension". The new classification may make a new dilemma in the management since the main treatment of pre-hypertension is the lifestyle changes. What do we recommend to lean patients with pre-hypertension who are already following a prudent lifestyle? The ultimate public health goal of antihypertensive therapy is the reduction of cardiovascular and renal morbidity and mortality. The question is, what should the blood pressure goal be? For patients without any compiling condition, it was assumed that 140/90 mmHg was desired treatment target level. For diabetic patient, it is reasonable to target a blood pressure well within the normal range, at most 130/80 mmHg. Some newer studies suggest that the target of treatment may force the recommended goal even lower, even for the patient without any compiling condition. For elderly individuals, a goal of 140/90 mmHg is appropriate. Hypertension during pregnancy is one of important aspects, since blood pressure during pregnancy may change related to the gestational age. This is always subject of discussion because there is no evidence that pharmacologic treatment results in improved neonatal outcomes, lower blood pressure may, in fact uteroplacental perfusion and thereby jeopardize fetal development. It means that more attention is needed for hypertensive patients not only for treatment regimens choice but also the blood pressure target. The accurate measurement of blood pressure is the sine qua non for successful management of hypertension. The operator should be trained and regularly retrained in the standardized technique, to avoid the chance of mismanagement.