Broader Definition Of Hypertension

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'A low, or declining, diastolic blood pressure has been linked to vessel wall thickening associated with progression of atherosclerosis and therefore may be an indication of widespread arterial disease and increased risk of cardiovascular mortality.

65 70 75 80 85 90 95 100 105 110 115

FIGURE 3. The "J-curve" for cardiovascular mortality and diastolic blood pressure (DBP). Low DBP may be a consequence rather than a cause of increased mortality.

65 70 75 80 85 90 95 100 105 110 115

DBP (mmHg)

FIGURE 3. The "J-curve" for cardiovascular mortality and diastolic blood pressure (DBP). Low DBP may be a consequence rather than a cause of increased mortality.

alcohol, or has evidence of left ventricular hypertrophy (LVH) (voltage criteria on electrocardiogram, cardiomegaly on chest radiograph, or more reliably, increased LV wall thickness on echocardiogram) has a higher risk of stroke or myocardial infarction than the uncomplicated hypertensive with a BP of 170/ 100 (Fig. 4) [11], This has implications not only for the target level of BP control, but for the modes of treatment used, which must also address these other risk factors [1]. In the setting of renal impairment and proteinuria, especially in diabetes mellitus, control of BP is essential in limiting the otherwise progressive decline in renal function.

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FIGURE 4. Arbitrary representation of cardiovascular risk related to systolic blood pressure (SBP) and additional risk factors (Other), including diabetes, hyperlipidemia, tobacco consumption, and left ventricular hypertrophy.

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