Hypertension: Classification, Pathophysiology, and Management During Outpatient Sedation and Local Anesthesia

Abstract

Hypertension is defined as a systolic blood pressure (SBP) higher than 140 mHg or a diastolic blood pressure (DBP) higher than 90 mmHg; the diagnosis is based on the average of 2 or more readings taken at each of 2 or more visits after an initial screening. 1 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 2003 Google Scholar , 2 Carter B.L. Highlights of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Am J Health Syst Pharm. 1998; 55: 382 PubMed Google Scholar When determined by these criteria, hypertension affects 20% to 30% of the adult population in most developed countries, and its prevalence appears to increase with the age of the patient. 3 Brown M.J. Haydock S. Pathoaetiology, epidemiology and diagnosis of hypertension. Drugs. 2000; 59: 1 Crossref PubMed Scopus (43) Google Scholar , 4 Pardell H. Tresserras R. Armario P. et al. Pharmacoeconomic considerations in management of hypertension. Drugs. 2000; 59: 13 Crossref PubMed Scopus (40) Google Scholar , 5 Schoen F.J. Blood vessels. in: Kumar V. Abbas A.K. Fausto N. Robbins and Cotran Pathologic Basis of Disease. (ed 7). Saunders, Philadelphia, PA2004: 511-529 Google Scholar Recent publications have shown that the lifetime risk of hypertension for patients who are normotensive at age 55 is 90%. 1 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 2003 Google Scholar African Americans are affected by hypertension nearly twice as often as whites and seem to be more vulnerable to its complications. 5 Schoen F.J. Blood vessels. in: Kumar V. Abbas A.K. Fausto N. Robbins and Cotran Pathologic Basis of Disease. (ed 7). Saunders, Philadelphia, PA2004: 511-529 Google Scholar , 6 Ashaye M.O. Giles W.H. Hypertension in blacks A literature review. Ethn Dis. 2003; 13: 456 PubMed Google Scholar Hypertension is an important risk factor for cardiovascular accidents, coronary heart disease, cardiac hypertrophy with heart failure (hypertensive heart disease), aortic dissection, and renal failure. Hypertension can also accelerate atherogenesis and can induce changes favorable for aortic dissection and cerebrovascular hemorrhage. 7 Burt V.L. Cutler J.A. Higgins M. et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population data from the Health Examination Surveys, 1960 to 1991. Hypertension. 1995; 26: 60 Crossref PubMed Scopus (1197) Google Scholar Despite the prevalence of hypertension and its associated complications, only 29% of patients with hypertension are treated, and only 45% of those treated with antihypertensive medications have controlled disease. 7 Burt V.L. Cutler J.A. Higgins M. et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population data from the Health Examination Surveys, 1960 to 1991. Hypertension. 1995; 26: 60 Crossref PubMed Scopus (1197) Google Scholar , 8 Pickering T.G. Optimal blood pressure levels. Am J Hypertens. 1998; 11: 877 Crossref PubMed Scopus (2) Google Scholar