News: Definition of Hypertension Could Change Again

Definition of Hypertension Could Change Again
http://my.webmd.com/content/Article/106/108025.htm

Doctors have proposed a new definition of hypertension, taking the
emphasis away from the blood pressure numbers and placing it on a
person's overall risk of heart disease and stroke.


By Charlene Laino
WebMD Medical News Reviewed By Charlotte Grayson, MD
on Monday, May 16, 2005
Emphasis Removed From Blood Pressure Numbers, Placed on Overall Risk

May 16, 2005 - Hypertension - Hypertension may be redefined again.

At a recent meeting of hypertension experts, doctors proposed a new
definition of hypertension, taking the emphasis away from the blood
pressure numbers and placing it on a person's overall risk of heart
disease and stroke.

It's not that your doctor won't take your blood pressure anymore. It's
just that the reading will be one part of a global cardiovascular
disease risk assessment that takes into account everything from whether
you smoke to your cholesterol levels, as well as evidence of organ
damage from hypertension or cardiovascular disease.

Smoking and high cholesterol are risk factors for cardiovascular
disease.

Hypertension, or high blood pressure, is also linked to an increased
risk of cardiovascular disease, such as heart attack and stroke.
Cardiovascular disease is the No. 1 cause of death in the U.S. "The
numbers are important, but the risk for hypertension is part of a
continuum," says Thomas Giles, MD, president of the American Society of
Hypertension (ASH) and an author of the definition. "You don't go from
being well to being sick because your blood pressure reading went up
one point."

The new definition is not a guideline for treatment but rather a
wake-up call for doctors and patients to understand that treatment of
hypertension requires attention to something more than just a number,
says Giles, who is also a professor of medicine at the Louisiana State
University School of Medicine in New Orleans.

"Under the new definition," he says, "statins that lower cholesterol
might be considered antihypertensive drugs, and antidiabetes drugs
might be considered antihypertensive drugs."

Giles, who outlined the new definition this weekend at the ASH annual
meeting in San Francisco, says it is being finalized for publication in
a major medical journal.


A New Definition of Hypertension

A New Definition of Hypertension

Federal guidelines that came out in 2003 classified hypertension by
blood pressure reading. High blood pressure is considered to be a
systolic blood pressure (the top number) of greater than 140 or a
diastolic blood pressure (the bottom number) of greater than 90.

"Normal" blood pressure is less than 120/80.

The 2003 guidelinesThe 2003 guidelines also placed nearly one in four
Americans who once thought they had normal blood pressure levels into a
prehypertension risk category. The prehypertension category includes
about 45 million men and women who have a systolic blood pressure
between 120 and 139 or a diastolic blood pressure of 80 to 89.

The new definition released this weekend changes this; it classifies
"normal individuals" as having normal blood pressure, loosely defined
as a systolic pressure of 115 and a diastolic pressure of 75 PLUS no
signs of heart disease or stroke, few if any risk factors for
cardiovascular disease, and no apparent damage from high blood pressure
to the kidneys or other organs.

Cardiovascular risk factorsCardiovascular risk factors include age,
sex, abnormal cholesterol and triglyceride levels, obesity as measured
by body mass index (BMI), smoking, and family history of cardiovascular
diseases such as heart disease or stoke.

Hypertensive organ damage can occur in the heart,heart,
arteries,arteries, brain,brain, kidneys,kidneys, and eyes.eyes.

Stage I, or mild, hypertension includes patients with occasional or
intermittent blood pressure elevations or early cardiovascular disease,
several risk factors for cardiovascular disease, but no organ damage.

Stage III, or severe, hypertension involves marked and sustained blood
pressure elevations or advanced cardiovascular disease and many risk
factors. A person's cholesterol level may be abnormal, and kidneys or
other organs may be damaged from the hypertension.

Stage II falls between the two.

'Good Riddance' to Prehypertension

The new definition also gets rid of the grey zone known as
prehypertension, Giles tells WebMD.

Richard Devereux, MD, tells WebMD that "he's enthusiastic about the
concept."

The new plan would redefine hypertension based on the actual level of
risk, says Devereux, professor of medicine at Weill Medical College of
Cornell University in New York.

He also supports the group's effort to get rid of the "confusing"
prehypertension category.

The new approach will "guide treatment to the 5 or perhaps 10 million
people in this ambiguous zone who actually need blood pressure-lowering
medication and let the others stop worrying," Devereux says.


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SOURCES: American Society of Hypertension's 20th Annual Scientific
Meeting and Exposition, San Francisco, May 14-18, 2005. Thomas Giles,
MD, president, American Society of Hypertension; professor of medicine,
Louisiana State University School of Medicine, New Orleans. Richard
Devereux, MD, professor of medicine, Weill Medical College, Cornell
University, New York.



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