tailieunhanh - Ebook Cardiology in family practice - A practical guide: Part 2

(BQ) Part 2 book “Cardiology in family practice - A practical guide” has contents: Congestive heart failure, hypertension, valvular diseases, pericardial diseases, prevention of bacterial endocarditis, hyperlipidemia. | Chapter 4 Hypertension Etiology and Pathophysiology Hypertension is highly prevalent in the United States and worldwide, and it is a major risk factor for coronary artery disease, stroke, heart failure, renal disease, and cardiovascular events [1]. The prevalence of hypertension increases with age. The Framingham Heart Study reported a 90% lifetime risk for developing hypertension in patients who are normotensive at the age of 50 [2]. The risk of cardiovascular disease doubles with each increment of 20/10 mmHg above 115/75 [3]. Systolic hypertension is now considered a more important risk factor than diastolic pressure [4, 5]. An estimated 50 million Americans have high blood pressure, but awareness, treatment, and control is still poor, especially in the elderly [6]. A national health survey performed from 1988 to 1991 [7], and repeated from 1999 to 2000 found that the prevalence of hypertension has increased from 20 to 27% over the past decade [6]. The 1999–2000 survey found that one third of hypertensive patients were not aware of their disease, less than two-thirds adopted lifestyle modification or took medication to lower their blood pressure, and only 31% were at their blood pressure goal [6]. It is little consolation that international blood pressure control rates were no better. Between 2004 and 2008, there was a () reduction in the rate of uncontrolled hypertension, indicating that progress has been made toward the American Heart Association’s (AHA) Impact 2010 goals for CHD and stroke [8]. The most recent AHA Impact 2020 goals call for even greater reductions in the prevalence of hypertension along with the other major risk factor for vascular disease (goal untreated BP 160 and 100 Once a patient is determined to be either prehypertensive or hypertensive, a thorough assessment of risk factors, possible secondary causes, and therapeutic targets should be initiated [12]. The physician should inquire about cigarette smoking, obesity, family history .