Epidemiology

Prevalence Increase with age 25% of the white males vs. 17% in white females 44% of black males vs. 37% in black femals Indifference between sexes at age < 65 y 76%of black vs. 63%of white.

Classification of BP Normal BP Prehypertensive state Stage I HTN Stage II HTN

Etiology of Hypertension Primary – 90-95% of cases – also termed “essential” of “idiopathic ” Secondary – about 5% of cases – Renal or renovascular disease – Endocrine disease Phaeochomocytoma Cusings syndrome Conn’s syndrome Acromegaly and hypothyroidism – Coarctation of the aorta – Iatrogenic Hormonal / oral contraceptive NSAIDs

PRINCIPLES OF TREATMENT Non-drug treatment Thresholds Begin with one drug Choice based on concomitant disease, risk factors Start low and titrate up [GO SLOW!] Add a second drug if poor control

TREATMENT THRESHOLDS BHS guidelines for drug treatment of hypertension Diastolic blood pressure > 110 mm Hg mm Hg mm Hg > 100 mm Hg TREAT OBSERVE Higher pressures within the range or older age > 60 years or coexisting risk factors or target organ damage Lower pressures within the range or younger age, without coexisting risk factors or target organ damage TREAT * * * Repeated measurements SBP > 160