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Hypertension treatment and control evolution from single risk and single organ to multirisks and multiorgans

Journal of Human Hypertension volume 22, pages 743–744 (2008)Cite this article

Over a half century ago, actuaries and life insurance companies recognized elevated blood pressure as associated with mortality risks.1 This early work identified systolic blood pressures of 20 mm Hg above the population average as associated with excess mortality. During this same period, studies determined that blood pressure levels could be significantly reduced with pharmacological agents.2, 3 Longitudinal epidemiological studies were implemented during the 1960s and 1970s, confirming the higher mortality associated with elevated blood pressure levels.4, 5, 6, 7 The analyses from these investigations demonstrated hypertension as a major risk factor for both genders, different races, all ages and different geographic locations. In addition to all-cause mortality, higher coronary heart disease mortality rates were identified in individuals with hypertension. With the risks from high blood pressure clearly identified and effective pharmaceuticals identified to reduce blood pressure, numerous studies and trials were implemented to assess the benefits of the treatment of hypertension. The early studies from the US Veterans Administration determined that blood pressure reduction among hypertensive individuals significantly reduced heart disease mortality.8 The Hypertension Detection and Follow-up Program further demonstrated that stepped care could be more effective in reducing blood pressure among hypertensive individuals with substantial cardiovascular disease risk reduction.9 The successes of these studies were translated to primary care with programmes such as the High Blood Pressure Education Program and the establishment of clinical guidelines, including the first report from the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure in 1977.10 These high-intensity strategies and efforts resulted in dramatic improvement in hypertension control in the population, with 10–29% of hypertensives achieving goal blood pressure. Six additional reports, newer classes of anti-hypertension treatments as well as lifestyle modification recommendations have been implemented for high blood pressure control. The later reports include recommendations based on evidence from studies and trials showing similar, as seen with coronary heart disease, improved outcomes among hypertensive patients with end-stage renal disease, peripheral vascular disease, congestive heart failure and stroke. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure 7 report in 2003 included treatment recommendation based on benefits for different organs.11 With the production of each issue of the guidelines, the number and types of end organs affected by elevated blood pressure were expanded, as well as refining the recommendations for treatment of elevated blood pressure among patients with specific organ involvement. The current recommendations also include hypertension treatments for individuals with diabetes, hyperlipidaemia and specific co-morbid conditions. In general, the treatment regimens are formed on risk reduction for a single end organ and/or condition. Although the recommendations have evolved in consideration of new studies and an increased number of treatments and strategies, high blood pressure control in the population has not improved at the rates seen with the first reports in the 1970s.12 In fact, only minimal improvement has been detected, and most of the racial and geographic disparities in control rates remain significant.

In this issue of the Journal of Human Hypertension, Cuspidi et al.13 describe the potential impact of multiple organ damage among individuals treated for hypertension. The first important finding with clinical implication is the relatively high prevalence of hypertensive patients with multiple organ damage. Although it is difficult to determine from this particular study which came first, the elevated blood pressure or the organ damage, the recognition of this higher risk population represents an important consideration for clinicians. The Evaluation of Target Organ Damage in Hypertension study was conducted in a specialist setting with referred patients; however, the implications are appropriate for all primary care providers identifying the importance of assessing high blood pressure involvement with multiple organs. In addition to the ruling out of secondary causes of hypertension, the consideration of multiple organs can be an indicator of disease progression and severity. As disease progression from elevated blood pressure may vary, markers of specific organ involvement should be included in the evaluation of the hypertensive patient. For example, the measurements of early disease indicators such as microalbumine and creatinine are important and cost-effective assessments in patients with hypertension.

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References

  1. Lew EA . Mortality statistics for life insurance underwriting. J Am Stat Assoc 1948; 43: 274–289.

    Google Scholar 

  2. Freis ED, Wilkins RW . Effects of pentaquine in patients with hypertension. Proc Soc Exp Biol Med 1947; 64: 455–458.

    Article  CAS  Google Scholar 

  3. Freis ED, Stanton JR, Moister FC . Assay in man of the clinical fractions of veratrum viride, and identification of the pure alkaloids germitrine and germidine as potent hypotensive principles derived from the drugs. J Pharmacol Exp Ther 1950; 98: 166–173.

    CAS  PubMed  Google Scholar 

  4. Lackland DT, Keil JE, Gazes PC, Hames CG, Tyroler HA . Outcomes of black and white hypertensive individuals after 30 years of follow-up. Clin Exp Hypertens 1995; 17: 1091–1105.

    Article  CAS  Google Scholar 

  5. Epstein FH, Ostrander Jr LD, Johnson BC, Payne MW, Hayner NS, Keller JB et al. Epidemiological studies of cardiovascular disease in a total community—Tecumseh, Michigan. Ann Intern Med 1965; 62: 1170–1187.

    Article  CAS  Google Scholar 

  6. Stamler J, Lendberg HA, Berkson DM, Shaffer A, Miller W, Poindexter A et al. Prevalence and incidence of coronary heart disease in strata of the labor force of a Chicago industrial corporation. J Chron Dis 1960; 11: 405–420.

    Article  CAS  Google Scholar 

  7. Keys A, Taylor HL, Blackburn H, Brozek J, Anderson JT, Simonson E . Coronary heart disease among Minnesota business and professional men followed fifteen years. Circulation 1963; 28: 381–395.

    Article  CAS  Google Scholar 

  8. Veteran Administration. Cooperative Study group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 1967; 202: 1028–1034.

    Article  Google Scholar 

  9. Hypertension Detection and Follow-up Program Cooperative Group. Five-year findings of the hypertension detection and follow-up program. I. Mortality by race-sex and age. Reduction of mortality of persons with high blood pressure, including mild hypertension. JAMA 1979; 242: 2562–2571.

    Article  Google Scholar 

  10. A cooperative study. Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 1977; 237: 255–261.

    Article  Google Scholar 

  11. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.

    Article  CAS  Google Scholar 

  12. Ong KL, Cheung BMY, Man YB, Lau CP, Lam KSL . Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension 2007; 49: 69–75.

    Article  CAS  Google Scholar 

  13. Cuspidi C, Valerio C, Negri F, Sla C, Masaidi M, Giudici V et al. Prevalence and correlates of multiple organ damage in referred treated hypertensives: data from the ETODH Study. J Hum Hypertens 2008; 22: 801–803.

    Article  CAS  Google Scholar 

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  1. Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC, USA

    D T Lackland & A D Boan

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  1. D T Lackland
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Correspondence to D T Lackland.

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Lackland, D., Boan, A. Hypertension treatment and control evolution from single risk and single organ to multirisks and multiorgans. J Hum Hypertens 22, 743–744 (2008). https://doi.org/10.1038/jhh.2008.58

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