Hipertensão arterial

Abstract

Hypertension (systolic pressure ≥ 140 mmHg or diastolic ≥ 90 mmHg) has high prevalence in developed countries. It occurs in one of four individuals in such communities, and normotensive individuals over 50 years have a 90% likelihood of developing high blood pressure during the next 25 years. The prevalence is higher among blacks and older persons, especially older women. Cardiovascular risk from systolic hypertension begins at 115 mmHg and risk from diastolic hypertension begins at 75 mmHg. The JNC 7 report demonstrated that the burden of hypertension (heart attacks, heart failure, stroke, kidney disease) can be attenuated by lowering blood pressure toward a new goal level of 120/80 mmHg. Accurate measurement of blood pressure and verification of elevated pressure on multiple occasions over time are important. Blood pressure that is elevated when measured during an office visit but that is otherwise normal ("White-coat hypertension"), present in 20% of patients with elevated blood pressure, may be a precursor of sustained hypertension and therefore warrants monitoring. Evaluation should identify signs of cardiovascular, cerebrovascular, or peripheral vascular disease as well as other cardiovascular risk factors commonly present with hypertension. Urinalyses, complete blood count, 12-lead electrocardiography, blood chemical tests (creatinine, sodium, potassium, fasting glucose, total cholesterol, and high-density lipoprotein) are routinely indicated. The majority of cases of hypertension can be prevented and controlled but this requires commitment to the task. The primary goal of the treatment is to prevent cardiovascular disease and death. Lifestyle interventions should be advocated as first line treatment in all cases. Determination of the need for drug therapy is based on a combined assessment of the blood-pressure level and the absolute risk of cardiovascular disease. Lifestyle modification and antihypertensive drugs are indicated for patients with cardiovascular or other target-organ disease (renal, cardiac, cerebrovascular, or retinal disease) and for those with stage 2 or 3 hypertension. Patients with diabetes are at high risk, and drug therapy is indicated in such patients even if blood pressure is at the high end of normal range.