Monitoring of Blood Pressure: Hypertension Morbidity and Mortality
Hypertension in adults traditionally has been defined as having a systolic blood pressure greater than or equal to 140 mmHg and/or a diastolic blood pressure greater than or equal to 90 mmHg, or taking antihypertensive medication. Morbidity and mortality as a result of cardiovascular disease are directly related to the level of blood pressure. Hypertension is a risk factor for stroke, myocardial infarction, and sudden cardiac death. Heart disease is the leading cause of death in the U.S., and stroke is the third. Hypertension was listed on death certificates as a primary or contributing cause of death in approximately 210,000 Americans in 1998.
There is considerable experimental, epidemiological, and clinical evidence indicating that reducing elevated blood pressure is beneficial, particularly in high-risk patients. In patients with type 2 diabetes mellitus, in whom the prevalence of hypertension is twice as high as in patients without diabetes, the risk of cardiovascular disease is doubled when hypertension is also present. Control of hypertension in patients with diabetes has been demonstrated conclusively to reduce the rate of progression of diabetes-related nephropathy and to reduce the complications of hypertension-related nephropathy, cerebrovascular disease, and cardiovascular disease. According to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), the blood pressure goals for patients with hypertension are to achieve and maintain systolic BP below 140 mmHg and diastolic below 90 mmHg, and lower if tolerated. Treatment to lower levels may be useful to prevent stroke, preserve renal function, and prevent or slow heart failure progression. The goal blood pressure for patients with diabetes is less than 130/85 mmHg. For patients with proteinuria in excess of 1 gram per 24 hours, the BP goal is less than 125/75 mmHg.
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