Diagnosis, prevention, and treatment of hypertensive heart disease

Abstract

Hypertension is an independent risk factor for cardiovascular disease events. There is a continuous relationship between both systolic and diastolic blood pressure levels and the chance of a heart attack or heart failure beginning at a blood pressure of 115/75 mmHg (Lewington et al., Lancet 360:1903-1913, 2002). The heart, central nervous system, kidneys, and peripheral arterial system are the major target organs that are susceptible to hypertensive disease. The most important treatment goal, however, is blood pressure control, and the choice of agent used to reach treatment goals may be less important. Although clinical trial data is lacking, a treatment target of 130/80 mmHg as recommended by the AHA is a reasonable target until further studies better define the optimal blood pressure in patients with established heart disease. Care may be needed in the elderly and patients with advanced diabetes and severe CAD to avoid treating too low blood pressure with the possibility of increasing adverse effects.