Skip to main content
SpringerLink
Log in

Hypertension as a Candidate for Disease Management Initiatives

Screening and Diagnosis

  • Review Article
  • Diagnosis
  • Published:
Disease Management and Health Outcomes

Summary

Hypertension, i.e. high systemic arterial pressure, is quantitatively related to future cardiovascular and renal insufficiency. Furthermore, treatment of hypertension is beneficial. Hypertension is therefore, one of the most important cardiovascular risk factors accounting for preventable disease. For individual patients, initial diagnostic strategies for hypertension should consider: (i) the need to determine average or usual levels of systolic and diastolic pressure, sometimes by employing the supplemental methods of ambulatory blood pressure monitoring or home blood pressures; (ii) the presence or absence of non-hypertensive reversible cardiovascular risk factors, particularly smoking, elevated serum lipid levels or diabetes mellitus; (iii) the presence or absence of pathological states related to hypertension and the other risk factors affecting the heart, arteries and kidneys; and (iv) the possibility of reversible causes of elevated blood pressure (secondary hypertension).

Combining assessments for these factors allows calculation of the absolute cardiovascular risk for each patient and, thus, their likelihood for benefit from various interventions, especially antihypertensive drug therapy. As hypertension is a chronic disorder, comprehensive assessment includes provisions for sustained observation, reassessment and adjustment of both diagnostic and therapeutic approaches. Optimal care of patients with hypertension represents the merging of older concepts of preventive medicine with recently recognised and emerging strategies for ongoing appraisal and intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anonymous. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997; 157: 2413–45.

    Article  Google Scholar 

  2. Pickering G. Systemic arterial hypertension. In: Fishman AP, Richards DW, editors. Circulation of the blood: men and ideas. New York: Oxford University Press, 1964: 487–541.

    Google Scholar 

  3. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet 1990; 335: 827–38.

    Article  PubMed  CAS  Google Scholar 

  4. Hebert PR, Moser M, Mayer J, et al. Recent evidence on drug therapy of mild to moderate hypertension and decreased risk of coronary heart disease. Arch Intern Med 1993; 153: 578–81.

    Article  PubMed  CAS  Google Scholar 

  5. Kostis JB, Davis BR, Cutler J, et al. Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1997; 278: 212–6.

    Article  PubMed  CAS  Google Scholar 

  6. Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995; 310: 452–4.

    Article  PubMed  CAS  Google Scholar 

  7. Alderman MH, Cushman WC, Hill MN, et al. International roundtable discussion of national guidelines for the detection, evaluation, and treatment of hypertension. Am J Hypertens 1993; 6: 974–81.

    PubMed  CAS  Google Scholar 

  8. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335: 765–74.

    Article  PubMed  CAS  Google Scholar 

  9. Fang J, Madhavan S, Cohen H, et al. Measures of blood pressure and myocardial infarction in treated patients. J Hypertens 1995; 13: 413–9.

    Article  PubMed  CAS  Google Scholar 

  10. Bruce NG, Shaper AG, Walker M, et al. Observer bias in blood pressure studies. J Hypertens 1988; 6: 375–80.

    Article  PubMed  CAS  Google Scholar 

  11. Hayward RSA, Steinberg EP, Ford DE, et al. Preventive care guidelines: 1991. Ann Intern Med 1991; 114: 758–83.

    PubMed  CAS  Google Scholar 

  12. Perry HMJ, Miller JP Difficulties in diagnosing hypertension: implications and alternatives. J Hypertens 1992; 10: 887–96.

    Article  PubMed  Google Scholar 

  13. MacDonald LA, Sackett DL, Haynes RB, et al. Labelling in hypertension: a review of the behavioral and psychological consequences. J Chron Dis 1987; 37: 933–42.

    Article  Google Scholar 

  14. Mancia G, Bertinieri G, Grassi G, et al. Effects of blood pressure measurement by the doctor on patient’s blood pressure and heart rate. Lancet 1983; II: 695–8.

    Article  Google Scholar 

  15. Pickering TG, James GD, Boddie C, et al. How common is white coat hypertension? JAMA 1988; 259: 225–8.

    Article  PubMed  CAS  Google Scholar 

  16. Hoegholm A, Kristensen KS, Madsen NH, et al. White coat hypertension diagnosed by 24-h ambulatory monitoring. Am J Hypertens 1992; 5: 64–70.

    PubMed  CAS  Google Scholar 

  17. Perloff D, Sokolow M, Cowan R. The prognostic value of ambulatory blood pressures. JAMA 1983; 249: 2792–8.

    Article  PubMed  CAS  Google Scholar 

  18. Coats AJS, Radaelli R, Clark SJ, et al. The influence of ambulatory blood pressure monitoring on the design and interpretation of trials in hypertension. J Hypertens 1992; 10: 385–91.

    Article  PubMed  CAS  Google Scholar 

  19. Verdecchia P, Porcellati C, Schillaci G, et al. Ambulatory blood pressure: an independent predictor of prognosis in essential hypertension. Hypertension 1994; 24: 793–801.

    Article  PubMed  CAS  Google Scholar 

  20. Schnall PL, Pieper C, Schwartz JE, et al. The relationship between ‘job strain’, workplace diastolic pressure, and leftven-tricular mass index: results of a case control study. JAMA 1990; 263: 1929–35.

    Article  PubMed  CAS  Google Scholar 

  21. White WB, Schulman P, McCabe EJ, et al. Average daily blood pressure, not office blood pressure, determines cardiac function in patients with hypertension. JAMA 1989; 261: 873–7.

    Article  PubMed  CAS  Google Scholar 

  22. Rowlands DB, Glover DR, Ireland MA, et al. Assessment of left-venticular mass and its response to antihypertensive treatment. Lancet 1982; I: 467–70.

    Article  Google Scholar 

  23. Moore CR, Krakoff LR, Phillips RA. Confirmation or exclusion of stage I hypertension by ambulatory blood pressure monitoring. Hypertension 1997; 29: 1109–13.

    Article  PubMed  CAS  Google Scholar 

  24. Eison H, Phillips RA, Ardeljan M, et al. Differences in ambulatory blood pressure between men and women with mild hypertension. J Hum Hypertens 1990; 4: 400–4.

    PubMed  CAS  Google Scholar 

  25. Pearce KA, Grimm RH, Rao S, et al. Population-derived comparisons of ambulatory and office blood pressures: implications for the determination of usual blood pressure and the concept of white coat hypertension. Arch Intern Med 1992; 152: 750–6.

    Article  PubMed  CAS  Google Scholar 

  26. Verdecchia P, Schillaci G, Boldrini F, et al. Variability between current definitions of ‘normal’ ambulatory blood pressure. Hypertension 1992; 20: 555–62.

    Article  PubMed  CAS  Google Scholar 

  27. Staessen J, Fagard RH, Ljinen PJ, et al. Mean and range of the ambulatory pressure in normotensive subjects from a meta-analysis of 23 studies. Am J Cardiol 1991; 67: 723–77.

    Article  PubMed  CAS  Google Scholar 

  28. Krakoff LR. Economic analysis of methods for supplemental measurement of blood pressure: ambulatory blood pressure monitoring and home, self-measured pressures. In: Waeber B, O’Brien E, O’Malley K, et al., editors. Twenty-four-hour blood pressure monitoring in clinical practice. New York: Raven Press, 1994: 97–105.

    Google Scholar 

  29. Sundberg S, Kohvakka A, Gordin A. Rapid reversal of circadian blood pressure rhythm in shift workers. J Hypertens 1988; 6: 393–6.

    Article  PubMed  CAS  Google Scholar 

  30. Baumgart P, Walger P, Fuchs G, et al. Twenty-hour blood pressure is not dependent on endogenous circadian rhythm. J Hypertens 1989; 7: 331–4.

    Article  PubMed  CAS  Google Scholar 

  31. Bursztyn M, Mekler J, Wachtel N, et al. Siesta and ambulatory blood pressure monitoring: comparability of the afternoon nap and night sleep. Am J Hypertens 1994; 7: 217–21.

    PubMed  CAS  Google Scholar 

  32. Gretler DD, Fumo MT, Nelson KS, et al. Ethnic differences in circadian hemodynamic profile. Am J Hypertens 1994; 7: 7–14.

    PubMed  CAS  Google Scholar 

  33. Soghikian K, Casper SM, Fireman BH, et al. Home blood pressure monitoring: Effect on use of medical services and medical care costs. Med Care 1992; 30: 855–65.

    Article  PubMed  CAS  Google Scholar 

  34. Chattelier G, Day M, Bobrie G, et al. Feasibility study of N-1 trials with blood pressure self-monitoring in hypertension. Hypertension 1995; 25: 294–301.

    Article  Google Scholar 

  35. Appel LJ, Stason WB. Ambulatory blood pressure monitoring and blood pressure self-measurement in the diagnosis and management of hypertension. Ann Intern Med 1993; 118: 867–82.

    PubMed  CAS  Google Scholar 

  36. Alderman MH. Blood pressure management: individualized treatment based on absolute risk and the potential for benefit. Ann Intern Med 1993; 119: 329–35.

    PubMed  CAS  Google Scholar 

  37. Alderman MH, Madhavan S, Ooi WL, et al. Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension. N Engl J Med 1991; 324: 1098–104.

    Article  PubMed  CAS  Google Scholar 

  38. Brunner HR, Laragh JH, Baer L, et al. Essential hypertension: renin, and aldosterone, heart attack and stroke. N Engl J Med 1972; 286: 441–9.

    Article  PubMed  CAS  Google Scholar 

  39. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997; 20: 1183–97.

    Google Scholar 

  40. Yudkin JS, Forrest RD, Jackson CA. Microalbuminuria as predictor of vascular disease in non-diabetic subjects. Lancet 1988; II: 530–3.

    Article  Google Scholar 

  41. Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322: 1561–6.

    Article  PubMed  CAS  Google Scholar 

  42. Koren MJ, Devereux RB, Casale PN, et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114: 345–5.

    PubMed  CAS  Google Scholar 

  43. Newman AB, Sutton-Tyrell K, Vogt MT, et al. Morbidity and mortality in hypertensive adults with a low ankle/arm index. JAMA 1993; 270: 487–9.

    Article  PubMed  CAS  Google Scholar 

  44. Frame PS, Fryback DG, Patterson C. Screening for abdominal aortic aneurysm in men ages 60 to 80 years. Ann Intern Med 1993; 119: 411–6.

    PubMed  CAS  Google Scholar 

  45. Peters AL, Davidson MB, Schriger DL, et al. A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. JAMA 1997; 276: 1248–52.

    Google Scholar 

  46. Shepard J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–7.

    Article  Google Scholar 

  47. Krakoff LR. Secondary or curable hypertension. In: Management of the hypertensive patient. New York: Churchill Livingstone, 1995: 75–86.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Englewood Hospital & Medical Center, 350 Engle Street, Englewood, New Jersey, 07631, USA

    Lawrence R. Krakoff (Professor of Medicine, Chief of Medicine)

  2. Mount Sinai School of Medicine, New York, New York, USA

    Lawrence R. Krakoff (Professor of Medicine, Chief of Medicine)

Authors
  1. Lawrence R. Krakoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krakoff, L.R. Hypertension as a Candidate for Disease Management Initiatives. Dis-Manage-Health-Outcomes 3, 215–228 (1998). https://doi.org/10.2165/00115677-199803050-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-199803050-00002

Keywords

Search

Navigation