Management of hypertension: update and review

ABSTRACT

Hypertension is one of the commonest diseases affecting humans throughout the world. The level of blood pressure has long been recognized as a determinant of risks for several common cardiovascular diseases including coronary heart disease and cerebrovascular disease. Cardiovascular disease presents a public health crisis, affecting over sixty million Americans with fifty million hypertensives, twelve million with coronary disease, seven million with myocardial infarction and over four million with stroke. Many of these categories are still growing with prevalence of hypertension increasing as population ages. High risk populations like the blacks have a higher frequency of end organ damage. They are also disproportionately affected by a variety of cardiovascular diseases and predisposing conditions like diabetes and obesity. The most recent classification of blood pressure designates a new category of prehypertension and patients in this category are at increased risk of hypertension. Adequate control remains an essential therapeutic approach to prevent complications and premature death. It is also an effective way to retard progression of diabetic and non-diabetic renal diseases. It is evident that treatment, regardless of approach has decreased mortality and morbidity. However, reports show that patients with well-controlled blood pressure represent only a small percentage of the hypertensive population. Thus there is clearly need to develop effective strategies to improve management. To this effect, National and International guidelines for management of hypertension have been issued. Recommendations as to forms of treatment regimens to be adopted including non pharmacological, monotherapy and appropriate combination therapy are discussed