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INTRODUCTION

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.

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. In 2017, the American College of Cardiology and American Heart Association updated their definitions to include diastolic >80 and systolic >129 (Table 21-1).

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Table 21-1 Classification of Blood Pressure
  • Systolic BP (mm Hg)

  • Diastolic BP (mm Hg)

JNC-VII Classification*

ACC/AHA Classification**

<120 and <80

Normal

Normal

120-129 and <80

Prehypertension

Elevated

130-139 or 80-89

Prehypertension

  • Stage 1

  • Hypertension

140-159 or 90-99

  • Stage 1

  • Hypertension

  • Stage 2

  • Hypertension

≥160 or ≥100

  • Stage 2

  • Hypertension

  • Stage 2

  • Hypertension

BP = blood pressure.

*Sources: From the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VII). JAMA. 2003;289:2560-2571, with permission; and **P. K. Whelton et al., 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults a report of the American College of Cardiology/American Heart Association Task Force on Clinical practice guidelines. Hypertension. 71 (2018), pp. E13–E115.

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 value.

When you are working with hypertensive patients, you are usually treating a problem other than the increased blood pressure—that is, hypertension is not usually the reason the patient is referred to 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.

The pharmacological management of hypertension has evolved to where blood pressure can be controlled for extended periods in most patients. Several ...

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