Epidemiology and the Prevention of Hypertension

Paul K. Whelton, MD, MSc

In This Article


Cardiovascular disease (CVD) is the most common cause of death in the United States and other economically developed countries and is a rapidly evolving cause of morbidity and mortality in economically developing nations. World Health Organization projections suggest that ischemic heart disease will soon be the most important, and stroke the fourth most important, contributor to disability-adjusted years of life lost on a worldwide basis. Optimal approaches to prevention of CVD are depicted in Figure 1. The most obvious and natural societal response is to ensure availability of care for patients with clinical manifestations such as coronary heart disease, heart failure, stroke, and renal insufficiency. Unfortunately, two major barriers limit the effectiveness of this approach. First, CVD often manifests as sudden death, with little opportunity for a treatment intervention. Second, it is difficult to reverse the underlying pathophysiology of CVD once it has developed. To produce a meaningful reduction in morbidity and mortality, management of patients with existing disease must be coupled with the treatment and prevention of major modifiable risk factors for CVD.[1] Currently, physicians only possess a rudimentary knowledge of the genetic underpinning of CVD; gene therapy for common forms of CVD is almost nonexistent. In contrast, several major, modifiable environmental risk factors for CVD are well established. High blood pressure (BP) is among the most important of these modifiable risk factors.[1,2] Knowledge of the prevalence of high BP and the extent to which it is being detected, treated, and controlled is essential to understanding the magnitude of the problem and how well it is being addressed. Strategies for definition, prevention, and treatment of hypertension are based on an extensive body of information that details the prevalence, distribution, risk implications, and environmental causes of high BP in the population. This article reviews current epidemiologic knowledge and the implications of data for prevention and treatment of BP-related cardiovascular complications.

Optimal model for prevention of cardiovascular disease (CVD).