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Hypertension is a sustained, reproducible increase in blood pressure. It is one of the most common diseases affecting adults living in industrialized nations. In the United States, for example, hypertension occurs in approximately 30 percent of the general population aged 20 and over.1,2 The prevalence of this disease can be even higher in certain subpopulations (e.g., 44 to 45 percent in African Americans), and the incidence of hypertension increases with age.2,3 If left untreated, the sustained increase in blood pressure associated with hypertension can lead to cardiovascular problems (stroke, heart failure), renal disease, and blindness.4,5 These and other medical problems ultimately lead to an increased mortality rate in hypertensive individuals.
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Although there is a general consensus regarding the adverse effects of hypertension, some debate exists as to exactly how much of an increase in blood pressure constitutes hypertension. Generally, diastolic values greater than 90 mm Hg and/or systolic values greater than 140 mm Hg warrant a diagnosis of hypertension. Patients are classified as prehypertensive, stage 1, or stage 2, depending on the extent of their elevated blood pressure. A more detailed classification scheme is shown in Table 21-1.
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Hypertension is often described as a silent killer because of the lack of symptoms throughout most of the disease course. Patients may feel fine into the advanced stages of hypertension. As might be expected, the incidence of morbidity and mortality increases as the hypertension becomes more severe. Hence, pharmacological and nonpharmacological methods are implemented to decrease blood pressure to an optimal diastolic value of 80 mm Hg or less and an optimal systolic value less than 120 mm Hg.
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When you are dealing with hypertensive patients, you are usually treating a problem other than the increased blood pressure—that is, hypertension is not the reason the patient is referred to physical therapy and occupational therapy. Due to the prevalence of hypertension, however, many patients receiving therapy for other problems will also be taking antihypertensive drugs. These drugs can also affect heart rate and vascular responses to aerobic exercise, mobility training, physical agents, and various other rehabilitation interventions. Hence, it is essential that you have knowledge of the pharmacology of these agents.
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The pharmacological management of hypertension has evolved to where blood pressure can be controlled for extended periods in most patients. Several major categories of antihypertensive agents are currently available, and new drugs ...