Cardiovascular disease risk due to Hypertension

What is the cardiovascular disease risk?

The World Health Organization estimates that hypertension is directly responsible for 13% of all deaths worldwide, and its effect is largely independent of a country’s underlying wealth. The Center for Disease Control and Prevention determined that hypertension-related deaths for Americans 45 years of age and older (i.e., hypertension was listed as a cause of death on death certificates) increased 62% between 2000 and 2013, though, as a primary cause of death, hypertension remained stable during this time period (17.5% of all deaths). The Prospective Studies Collaboration, a meta-analysis of 1 million patients, showed that cardiovascular mortality risk began with BPs as low as 115/75 mm Hg, and, for patients 40 to 69 years old, each 20/10 mm Hg increase in BP increased cardiovascular mortality 2-fold.

Whether a J-curve—the point at which low BPs treated within the physiologic range increase cardiovascular risk—exists, is controversial. This is of interest, as the coronary arteries receive significant perfusion during diastole; low diastolic BPs may predispose patients to adverse outcomes. The Prospective Studies Collaboration did not note a J-curve, though older studies have, especially in hypertensive patients with underlying cardiovascular disease who achieve diastolic BPs <85 to 90 mmHg.

CKD imparts increased cardiovascular risk as well. A large meta-analysis of nearly 267,000 patients with diabetes mellitus, hypertension, or cardiovascular disease showed that both low estimated GFRs and albuminuria independently increased all-cause and cardiovascular mortality. Compared to patients with an estimated GFR of 95, cardiovascular mortality risk increased 73% in patients with an estimated GFR of 45, and increased 208% in patients with an estimated GFR of 15. Patients with albumin-to-creatinine ratios of 10, 30, and 300 mg/g experienced a 13%, 55%, and 159% increase in cardiovascular mortality risk, compared to patients with an albumin-to-creatinine ratio of 5 mg/g.

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