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Hypertension is intricately entwined in vascular pathology and morbidity and uncontrolled blood pressure is a leading cause of cardiovascular mortality. Unfortunately, many patients will present to the vascular surgeon with uncontrolled blood pressure elevation and yet, although vascular surgeons have been involved in treating the renovascular etiology, they seldom become actively involved in the medical management of hypertension. However, positive reinforcement by the vascular surgeon about the benefits of blood pressure control may significantly impact the patient's willingness to comply with medications. Some of these medications may also have secondary benefits such as reducing the incidence of diabetes. Accordingly modern vascular surgeons, who want to do more for their patients, need to have a basic understanding of hypertension and its treatment. This manuscript provides an overview of the modern definitions and treatment methods for primary hypertension that should provide the vascular surgeon with sufficient information to play an active role in the management of this co-morbid condition.
Introduction
Hypertension is intricately entwined in vascular pathology and morbidity, and uncontrolled blood pressure is a leading cause of cardiovascular mortality. Unfortunately, many patients will present to the vascular surgeon with uncontrolled blood pressure elevation, and yet, although vascular surgeons have been involved in treating the renovascular etiology, they seldom become actively involved in the medical management of hypertension. However, positive reinforcement by the vascular surgeon about the benefits of blood pressure control may significantly impact the patient's willingness to comply with medications. Some of these medications may also have secondary benefits such as reducing the incidence of diabetes. Accordingly modern vascular surgeons who want to do more for their patients need to have a basic understanding of hypertension and its treatment.
Epidemiology of Hypertension
Hypertension is reaching epidemic proportions with more than 1 billion people thought to be hypertensive.1 The Third National Health and Nutrition Examination Survey (NHANES III)2 estimated that the age-adjusted prevalence of hypertension in the United States is 32% in non-Hispanic black and 23% in non-Hispanic white and Mexican-American populations. In patients over the age of 60 years these numbers increase to 65% and 80% in non-Hispanic black men and women and 55% and 65% in non-Hispanic white men and women. Despite this prevalence, NHANES III estimates that adequate blood pressure control...