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Hypertension is usually treated to achieve a blood pressure of below 140/90 mmHg to 160/100 mmHg. According to one 2003 review, reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21% and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. [1]
Hypertension is also associated with decreased peripheral venous compliance, [77] which may increase venous return, increase cardiac preload and, ultimately, cause diastolic dysfunction. For patients having hypertension, higher heart rate variability (HRV) is a risk factor for atrial fibrillation. [78]
Commonly, ischemic heart attack and stroke are the causes that lead to death in patients with severe hypertension. It is estimated that for every 20 mm Hg systolic or 10 mm Hg diastolic increase in blood pressures above 115/75 mm Hg, the mortality rate for both ischemic heart disease, cancer and stroke doubles.
The incidence of stroke rises progressively with increasing blood pressure levels, particularly systolic blood pressure in individuals >65 years. Treatment of hypertension convincingly decreases the incidence of both ischemic and hemorrhagic strokes. [41] Hypertension is also associated with impaired cognition in an aging population.
The fundamental goal of treatment should be the prevention of the important endpoints of hypertension, such as heart attack, stroke and heart failure. Patient age, associated clinical conditions and end-organ damage also play a part in determining dosage and type of medication administered. [3]
Resistant hypertension: add spironolactone ACC / AHA 2017 [13] General <130/80 BP > 130/80: Lifestyle changes and monotherapy with thiazide-type diuretic, ACEI/ARB, and/or CCB BP >20/10 above target: Lifestyle changes and two from different classes: thiazide-type diuretic, ACEI/ARB, and/or CCB JNC 8 2013 [1] General age ≥60 General age <60 ...
The most common presentation of cerebrovascular disease is an ischemic stroke or mini-stroke and sometimes a hemorrhagic stroke. [2] Hypertension (high blood pressure) is the most important contributing risk factor for stroke and cerebrovascular diseases as it can change the structure of blood vessels and result in atherosclerosis . [ 5 ]
The prevalence of labile hypertension in USA is estimated to have more than 40 million adults which can develop the risks of hemorrhagic stroke. [15] Labile hypertension is most common in Charlottesville, Virginia with up to 11% of the population. Average age who have labile hypertension is 64±13 years. [16]