What Are the Thresholds for Initiating Treatment for High Blood Pressure As Listed in the Current ACC/AHA Guidelines?
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Annually, China spends more than $3 billion on hypertension treatment and $30 billion on the treatment of CVD, representing a substantial share of its national health care resources. In the next 25 years, the financial burden of hypertension will increase even further as the number of hypertensive people is projected to grow by 65% by 2025.
Most of the book suggested that there is a debate regarding the pathophysiology of hypertension. A number of predisposing factors which contributes to increase the BP are obesity, insulin resistance, high alcohol intake, high salt intake, aging and perhaps sedentary lifestyle, stress, low potassium intake and low calcium intake. Furthermore, many of these factors are additive, such as obesity and alcohol intake.
Diet, 2004). An increasing number of antihypertensive combination products are available in a number of dosing especially in India. Although combination products are convenient it is often less expensive to use individual agents and titration of doses of the two agents is easier when the two drugs are prescribed separately. Once BP control is achieved with given doses of two agents, switching to the same therapy in combination is a good option. The advantages and disadvantages of using combination products have been reviewed. Caution is advised when using combination therapy in older persons and diabetic patients, because of the increased risk of precipitous declines in BP or aggravation of orthostatic hypotension. Goal BP may be difficult to achieve in some patients with systolic hypertension, but any reduction is beneficial. Thus, in some patients, a higher systolic goal may be reasonable. In patients who require drugs, lower initial doses should be considered, especially in the presence of orthostatism or co-morbid vascular diseases. Serum creatinine concentrations often increase acutely when these drugs are used, so serum creatinine and potassium should be measured within several days of initiating treatment. An increase in creatinine is not a reason to stop the drug unless it is excessive or associated with severe hyperkalaemia. Concomitant use of potassium-sparing diuretics, potassium supplements, or nonsteroidal anti-inflammatory drugs should be avoided (Gupta R, Joshi P, 2008). A persistent increase in creatinine with treatment raises the possibility of renal artery stenosis. Most patients with kidney disease will require a diuretic as part of the treatment regimen. If the estimated glomerular filtration rate is < 30 ml/min, thiazide diuretics are usually ineffective, and loop diuretics are required.
Sindhwani V. Role of dietary modification with zero-oil diet in coronary artery disease patients. MSc dissertation. Delhi: Delhi University; 2004.
Reddy KS, Katan MB. Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public Health Nutr. 2004;7:167–86.
Kim S, Popkin BM. Understanding the epidemiology of overweight and obesity: a real global public health concern. Int J Epidemiol. 2006;35:60–7. discussion 81-2.
Gupta R, Deedwania PC. Obesity and the metabolic syndrome: management issues. In: Mohan V, Rao GHR, editors. Type 2 diabetes in South Asians: Epidemiology, risk factors and prevention. New Delhi: Jaypee Brothers Medical Publishers; 2006. pp. 104–37.
Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart. 2008