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Subclinical organ damage moves hypertensive patients into high risk range for CVD

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In patients with hypertension, physicians should assess the presence of subclinical organ damage, an indication of high absolute risk for cardiovascular disease (CVD).

Even when blood pressure (BP) is in the high normal range, the risk of CVD is increased 2- to 3-fold when organ damage is particularly pronounced, affects multiple organs, or is accompanied by metabolic risk factors.

These conclusions are published in a reappraisal of the 2007 European guidelines on hypertension management, written by a European Society of Hypertension Task Force and appearing in the November Journal of Hypertension.

Lead author Dr. Giuseppe Mancia, from San Gerardo Hospital in Monza, Italy, and his international team report, “The results of new important studies (including several large randomized trials of antihypertensive therapy) have been published” since 2007.

They note that asymptomatic alterations of the cardiovascular and renal system are critical points linking hypertension to cardiovascular events and death.

They recommend that hypertensives be tested, both at screening and during treatment, for reduced estimated glomerular filtration rate or microalbuminuria or proteinuria, as well as electrocardiographic and echocardiographic evidence of vascular disease or left ventricular hypertrophy.

They also advise that physicians consider organ damage or diabetes when deciding whether to treat high normal blood pressure (systolic BP between 130 and 139 mm Hg, diastolic BP between 35 and 89 mm Hg), especially if lifestyle changes have not normalized BP.

The authors’ review of the current literature also includes information about when to initiate antihypertensive therapy, what blood pressure targets should be in the elderly, the diabetic, and the high risk patient, as well as how to choose among and combine available antihypertensive agents.

J Hypertens 2009.