Going Beyond Blood Pressure Numbers in Defining Hypertension

Newswise — A just-published recommendation for an expanded definition of hypertension urges physicians to look beyond the numbers obtained from blood pressure readings, and instead, view hypertension as a progressive cardiovascular syndrome that can begin before elevated blood pressure appears.

The proposal from the Hypertension Writing Group appears as a Position Paper in the September issue of The Journal of Clinical Hypertension, the official publication of the American Society of Hypertension (J Clin Hypertens. 2005;7:505-512). The recommendation is aimed at improving the way physicians conceptualize, diagnose and treat hypertension by encouraging them to think about the disease earlier than they commonly do now in order to reduce the risk of cardiovascular disease consequences that are linked to high blood pressure, such as heart attack and stroke.

"Early markers often are present before blood pressure elevation is observed," explained Thomas D. Giles, MD, president of the American Society of Hypertension, professor of medicine at the Louisiana State University School of Medicine in New Orleans and a member of the Writing Group that authored the Position Paper. "Therefore, we are recommending that the current definition and classification of hypertension be expanded by integrating additional clinical and pre-clinical manifestations."

The Journal of Clinical Hypertension article also noted that any hypertension treatment strategy "based on BP (blood pressure) measurements alone, without considering other signs of cardiovascular risk, is not recommended since it would involve treating a very large number of individuals who are not at significant risk of cardiovascular events."

"To identify individuals at risk for CVD (cardiovascular disease) at an earlier point in the disease process, as well as to avoid labeling persons as hypertensive who are a low risk for CVD," wrote Dr. Giles and his colleagues, "the Hypertension Writing Group proposes incorporating the presence or absence of cardiovascular risk factors, early disease markers, and target organ damage into the definition and classification scheme of hypertension."

Re-Defining Hypertension

Dr. Giles and his colleagues noted that the current definition and classification of hypertension are based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressures (JNC 7) that relies primarily on blood pressure thresholds for the diagnosis and treatment of the disorder.

The definition proposed by the Hypertension Writing Group characterizes hypertension as a constellation of symptoms --of which blood pressure is just one-- that arise for complex reasons, result in both functional and structural changes to the heart and vascular system, and can progress to damage in the heart, kidneys, brain, vasculature and other organs, often leading to premature morbidity and death. The authors recommend that "classification of hypertension must involve assessing global cardiovascular risk to situate an individual's risk for CVD and events along a continuum."

Additional Research Is Needed

Dr. Giles and his colleagues wrote that their recommendation to take a more global view of hypertension "is a transitional strategy that is intended to pave the way for further research and clinical investigations aimed at detecting and treating disease at an earlier phase."

In a Commentary accompanying The Journal of Clinical Hypertension article, Barry Materson, MD, MBA, of the Nephrology and Hypertension Division of the University of Miami Miller School of Medicine, questioned whether their approach is practical for primary care providers, but he commended Dr. Giles and his colleagues for having "challenged the research community and those agencies that fund them to address these issues aggressively." (J Clin Hypertens. 2005;7:540-541)

About the American Society of Hypertension

The American Society of Hypertension (ASH) is the largest US organization devoted exclusively to hypertension and related cardiovascular diseases. ASH is committed to alerting physicians, allied health professionals and the public about new medical options, facts, research findings and treatment choices designed to reduce the risk of cardiovascular disease. For more information, please visit www.ash-us.org.

The authors of The Journal of Clinical Hypertension article were Thomas D. Giles, MD; Bradford C. Berk, MD, PhD; Henry R. Black, MD; Jay N. Cohn, MD; John B. Kostis, MD; Joseph L. Izzo, Jr., MD; and Michael A. Weber, MD; on behalf of the Hypertension Writing Group.

About The Journal of Clinical Hypertension

The Journal of Clinical Hypertension, published by Le Jacq, Ltd. in Darien, Connecticut (http://www.lejacq.com), provides unbiased, peer-reviewed, clinically relevant information to a wide audience of practicing physicians treating hypertension and cardiovascular disease. It is distributed monthly to approximately 44,000 physicians in the United States, including cardiologists, family practitioners and internists, with the primary objective of bridging the "knowledge-practice gap" between researchers and practicing clinicians. The JHC is in its seventh year of continuous publication and is listed in the National Library of Medicine's Index Medicus.