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Nat Rev Dis Primers. 2018 Mar 22;4:18014. doi: 10.1038/nrdp.2018.14.

Hypertension.

Author information

1
Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, School of Medicine, The University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, Birmingham, AL, 35294-0007, USA.
2
Athens-Limestone Hospital, Athens, AL, USA.
3
The University of Chicago Medicine, Chicago, IL, USA.
4
Center for Healthcare Organization and Implementation Research, Bedford Veteran Affairs Medical Center, Bedford, MA, USA.
5
Schools of Medicine and Public Health, Boston University, Boston, MA, USA.
6
Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic.
7
Institute of Cardiovascular and Medical Science, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
8
Clinica Medica, University of Milano-Bicocca, Milan, Italy.
9
IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
10
Institute of Aerospace Medicine, German Aerospace Center (DLR), University of Cologne, Cologne, Germany.
11
Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK.
12
The George Institute for Global Health, Sydney, New South Wales, Australia.
13
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.

Abstract

Systemic arterial hypertension is the most important modifiable risk factor for all-cause morbidity and mortality worldwide and is associated with an increased risk of cardiovascular disease (CVD). Fewer than half of those with hypertension are aware of their condition, and many others are aware but not treated or inadequately treated, although successful treatment of hypertension reduces the global burden of disease and mortality. The aetiology of hypertension involves the complex interplay of environmental and pathophysiological factors that affect multiple systems, as well as genetic predisposition. The evaluation of patients with hypertension includes accurate standardized blood pressure (BP) measurement, assessment of the patients' predicted risk of atherosclerotic CVD and evidence of target-organ damage, and detection of secondary causes of hypertension and presence of comorbidities (such as CVD and kidney disease). Lifestyle changes, including dietary modifications and increased physical activity, are effective in lowering BP and preventing hypertension and its CVD sequelae. Pharmacological therapy is very effective in lowering BP and in preventing CVD outcomes in most patients; first-line antihypertensive medications include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, dihydropyridine calcium-channel blockers and thiazide diuretics.

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