Hypertension as a Candidate for Disease Management Initiatives: Screening and Diagnosis
Lawrence R. Krakoff
Hypertension, i.e. high systemic arterial pressure, is quantitatively related to future cardiovascular and renal insufficiency. Furthermore, treatment of hypertension is beneficial. Hypertension is therefore, one of the most important cardiovascular risk factors accounting for preventable disease. For individual patients, initial diagnostic strategies for hypertension should consider: (i) the need to determine average or usual levels of systolic and diastolic pressure, sometimes by employing the supplemental methods of ambulatory blood pressure monitoring or home blood pressures; (ii) the presence or absence of non-hypertensive reversible cardiovascular risk factors, particularly smoking, elevated serum lipid levels or diabetes mellitus; (iii) the presence or absence of pathological states related to hypertension and the other risk factors affecting the heart, arteries and kidneys; and (iv) the possibility of reversible causes of elevated blood pressure (secondary hypertension). Combining assessments for these factors allows calculation of the absolute cardiovascular risk for each patient and, thus, their likelihood for benefit from various interventions, especially antihypertensive drug therapy. As hypertension is a chronic disorder, comprehensive assessment includes provisions for sustained observation, reassessment and adjustment of both diagnostic and therapeutic approaches. Optimal care of patients with hypertension represents the merging of older concepts of preventive medicine with recently recognised and emerging strategies for ongoing appraisal and intervention.
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