Hypertension (HTN) affects an estimated 103 million persons aged 20 years or older in the United States and approximately 1.39 billion individuals worldwide. Individuals with hypertension are at greater risk for stroke, myocardial infarction (MI), heart failure, peripheral vascular disease, kidney disease, and retinal vascular complications. The prevalence of hypertension increases with age; it is typically familial and is also related to lifestyle behaviors. HTN is more common in non-Hispanic black persons than in Hispanic persons, and it is higher in both of those groups than in white persons. BP control rates are lowest in Mexican American and American Indian individuals. The prevalence and severity of hypertension are increased in black persons, in whom β-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) are less effective than diuretics and CCBs in lowering BP. High blood pressure prevalence is also increasing in the Hispanic population. The incidence of devastating complications is higher in lower socioeconomic groups because of greater prevalence, delayed detection, and poor control rates of multifactorial etiology. Antihypertensive therapy is effective in reducing cardiovascular morbidity and mortality, but only 59% of individuals with hypertension are treated, and only 69% of those individuals achieve a blood pressure of 140/90 mm Hg or lower, according to National Health and Nutrition Examination Surveys (NHANES) in the United States and similar cohorts in Canada and Europe. Under the new definition of hypertension (systolic pressure greater than or equal to 130 mm Hg and/or a diastolic greater than or equal to 80 mm Hg), only 47% of individuals undergoing hypertensive therapy will achieve controlled blood pressure. Unfortunately, for many minority patients, socioeconomic and lifestyle factors continue to be barriers to treatment.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.