Hyper tension is Taking On a 'New Look'

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Citation
US Cardiology 2006;2005:2(1):1-4

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Introduction

The concept of 'hypertensionÔÇÖ as a clinical entity has been a work in progress for decades. At some point, the diagnosis of hypertension began to be linked to specific levels of blood pressure. The Joint National Committee (JNCI-JNC7) reports provide a perspective and an understanding that a clearer and precise definition might avoid the dead-end that the current concept of hypertension has been leading the scientific community. The definition of hypertension has changed with each new JNC report as have the levels of blood pressure that are considered goals of therapy.

Blood pressure is a necessary physical force required to move blood through the body. There is, for each individual, an optimal blood pressure at rest and during physical activity ensuring that the proper quantity of blood is available for physiological needs, while not exposing the arterial system to excess force. An increase in blood pressure above the optimal level for an individual indicates that the cardiovascular (CV) system is abnormal in some way. If the pressure remains above optimal, damage to the circulation and organs receiving blood will be damaged.

It is not definitely known what causes arterial blood pressure to initially increase in most individuals with an elevated blood pressure. If the stiffness of the proximal arterial system increases, i.e. a decrease in vascular compliance, then an increases in systolic blood pressure follows. If there is a primary or reactive increase in the distal, pre-capillary arteriolar resistance, the diastolic and mean arterial blood pressure will also increase. Abnormalities in vascular function precede the initial increases in blood pressure.

There are now ample data that show a linear increase in CV risk for adverse outcomes for virtually all blood pressure values with risk beginning at approximately 115mmHg systolic.1-7 Blood pressure is therefore not only a 'testÔÇÖ of CV function, but participates in the pathophysiological process resulting in vascular and target organ damage, becoming a 'targetÔÇÖ for therapy. Small increases in blood pressure are associated with increases in all target organ morbid outcomes, i.e. stroke, coronary artery disease (CAD), renal disease, and peripheral vascular disease.

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