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Cardiovascular risks of hypertension

Michael J Bloch, MD, FACP, FASH, FSVM, FNLA
Jan Basile, MD
Section Editors
George L Bakris, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
John P Forman, MD, MSc


Hypertension is quantitatively the most important risk factor for premature cardiovascular disease; it is more common than cigarette smoking, dyslipidemia, and diabetes, which are the other major risk factors (table 1). Hypertension accounts for an estimated 54 percent of all strokes and 47 percent of all ischemic heart disease events globally [1]. (See "Overview of established risk factors for cardiovascular disease".)

The impact of hypertension on the risk for cardiovascular disorders and the impact of cardiovascular risk on therapeutic decisions in the treatment of hypertension are discussed in this topic. The effects of different antihypertensive drugs and of different blood pressure goals on cardiovascular outcomes are presented elsewhere. (See "Choice of drug therapy in primary (essential) hypertension" and "What is goal blood pressure in the treatment of hypertension?".)


Hypertension increases the risk for a variety of cardiovascular diseases [2,3], including stroke, coronary artery disease, heart failure, atrial fibrillation [4], and peripheral vascular disease.

The risk for both coronary disease and stroke increases progressively with incremental increases in blood pressure above 115/75 mmHg, as shown in numerous epidemiologic studies (figure 1A-B) [5-8]. However, these observations do not prove a causal relationship, since increasing blood pressure could be a marker for other risk factors such as increasing body weight, which is associated with dyslipidemia, glucose intolerance, and the metabolic syndrome. The best evidence for a causal role of increasing blood pressure in cardiovascular complications is an improvement in outcome with antihypertensive therapy [9]. (See "What is goal blood pressure in the treatment of hypertension?".)

The increase in cardiovascular risk has primarily been described in terms of elevated systolic pressure in those over age 60 years [10] and elevation in both systolic and diastolic pressure in younger individuals. Pulse pressure, which is the difference between the systolic and diastolic blood pressures and is determined primarily by large artery stiffness, is also a strong predictor of risk [10]. (See "Increased pulse pressure".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2017.
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