Hypertension (Blood Pressure) and Lifetime Risk of Target Organ Damage
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MECHANISMS OF HYPERTENSION AND TARGET-ORGAN DAMAGE (JE HALL AND ME HALL, SECTION EDITORS)
Hypertension (Blood Pressure) and Lifetime Risk of Target Organ Damage Daniel W. Jones 1
&
Donald C. Clark III 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this review is to describe the long-term or lifetime relationship between blood pressure and target organ damage. The use of the term “blood pressure” as opposed to hypertension is purposeful. The risk of cardiovascular disease from blood pressure begins below the levels of blood pressure defined as hypertension by contemporary definitions. Recent Findings An important recent publication that bears on this topic was the 2017 ACC/AHA Blood Pressure Management Guidelines. The redefinition of hypertension and blood pressure treatment goal to 130/80 mmHg and the decision to rely almost exclusively on data from event-based randomized controlled clinical trials, which led to a recommendation for lifestyle therapy only for most with stage 1 hypertension, were important. A report from the CARDIA study demonstrated significant risk for cardiovascular disease at 20 years for stage 1 hypertension. Summary Based on all evidence, clinicians should consider the use of medication for stage 1 hypertension in those uncontrolled on lifestyle therapy. Keywords Blood pressure . Hypertension . Cardiovascular disease . Risk . Young adult . Stage 1
Introduction The purpose of this paper is to describe the long-term or lifetime relationship between blood pressure (BP) and target organ damage and to understand the implications for management including prevention and treatment. Hypertension is the most common contributor to the development of atherosclerotic cardiovascular disease including coronary heart disease, stroke, and peripheral vascular disease. [1, 2] It is also associated with chronic kidney disease, vision loss, and sexual dysfunction.
This article is part of the Topical Collection on Mechanisms of Hypertension and Target-Organ Damage * Daniel W. Jones [email protected] 1
Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
2
Department of Medicine, Division of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
Hypertension is frequently referenced as “the silent killer” since the presence of hypertension is usually asymptomatic until there are symptoms of target organ damage. The relationship between elevated BP and target organ damage is continuous and graded [3]. However, an important issue in understanding the relationship between hypertension and target organ damage is to understand the nomenclature used to describe BP risk including normal BP, elevated BP, and high BP/hypertension. [4, 5••, 6–8] This nomenclature, used in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Blood Pressure Management Guidelines, describes categories of BP range as a convenient communication tool to guide clinicians in pat
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