ABSTRACT
It has been estimated that more than 40 million adults in the USA over the age of 25 have hypertension and that, of these, only about half are currently treated with medications.1 The vascular effects of elevated blood pressure promote atherothrombotic disease, with consequences for cardiac, cerebral, and renal function. Large epidemiological studies, such as the Framingham Heart Study, have shown that increasing systolic or diastolic blood pressure increases the likelihood of coronary events and mortality from coronary artery disease.2 The Cardiovascular Health Study confirmed a linear relationship between cardiovascular disease (CVD) risk and blood pressure in subjects ≥65 years of age.3 Similarly, the Multiple Risk Factor Intervention Trial (MRFIT) found a significant increase in the relative risk for coronary heart disease with increased blood pressure in a younger cohort of men (aged 35-47).4 Overall, these studies found the lowest CVD risk to be in patients with the lowest blood pressure. In numerous studies, treatments with antihypertensive agents have been found to decrease morbidity and mortality from cardiovascular disease,5 suggesting that optimal blood pressure control can contribute to improved quality of life. Notably, the decrease in stroke, renal failure, and heart failure rate is more pronounced than the decrease in the incidence of myocardial infarction (MI) accompanying a reduction in blood pressure.
