Patients with pre-hypertension

Patients with pre-hypertensionRecently revised guidelines "translated" the majority of persons with high normal pressure in a group of patients with pre-hypertension [Megafarm, materials Cardiosite.ru] "There is no such boundary, on one side which would be healthy people, and on the other face of risk," says Dr. Gregory Ewald, a specialist in heart failure, medical Director of the program of cardiorespiratory (Department of cardiology, Clinic Barnes-Jewish Hospital, St. Louis). According to reports published in may this year, the Seventh Report of the Joint National Committee on Prevention, detection, Evaluation and Treatment of high blood pressure, systolic blood pressure (BP) 120-139 mm RT. Art. and diastolic 80-89 mm RT. Art. is considered pre-hypertension. This required modification of lifestyle, prevent the development of cardiovascular complications. Cardiovascular risk begins to manifest itself when the HELL 115/75 mm RT. Art. increases with increase in pressure for every 20/10 mm RT. C. As noted in the report (Journal of the American Medical Association, may 21, 2003), in people 50 years or older systolic blood pressure above 140 mm RT. Art. is a more important factor of cardiovascular risk than elevated diastolic blood pressure. "As new data from a large epidemiological studies (Framingham and others), it becomes evident that by reducing the level of blood pressure is reduced and the risk of cardiovascular disease," says Dr. Ewald, who teaches in the School of Medicine at Washington University (St. Louis). "I believe that this was the main reason for revision". "People with a prestage of hypertension is necessary not only to monitor the level of pressure, but also change the way of life is to normalize the weight, limiting salt intake, increase physical activity. Medication they do not need - if there is no associated pathology, such as diabetes or kidney disease. In the latter case, it would be advisable to start taking ACE inhibitors," says Dr. Ewald. Those hypertensive patients who are already taking antihypertensive drugs, it is not necessary to change medications. Patients with stage 2 hypertension (systolic blood pressure above 160 mm RT. Art. or diastolic blood pressure above 100 mm RT. Art.) should immediately appoint a fairly aggressive medical therapy, not limited to one modification of lifestyle. The target pressure level remains blood pressure below 140/90 mm RT. Art. or below 130/80 mm RT. senior diabetes go pathology of the kidney. What has changed in the new recommendations? "Now as initial therapy for uncomplicated hypertension are recommended thiazide diuretics - apparently, because of the results of the study ALLHAT (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial)," suggests Dr. Ewald. As you know, in the ALLHAT study were compared thiazide diuretics, ACE inhibitors and calcium antagonists. It turned out that diuretics are not inferior to the other two classes of antihypertensive drugs. As a rule, the thiazide diuretic then added one or two of the drug - as monotherapy rarely allows to achieve adequate BP control. "In the United States less than half of all hypertensive patients (approximately 50 million) control the level of HELL... the fuller will be the new guidelines, the less will be the need for heart transplants," said Dr. Ewald. "Most cases of heart failure that I face are the result of years of uncontrolled hypertension. If we warn the transition of patients from a group of pre-hypertension in a group of hypertension, we will prevent the development of coronary heart disease, myocardial infarction, heart failure. This will have a significant positive effect on the population level, because the prevalence of hypertension remains high," concluded Dr. Ewald..



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