Clinical overview of hypertension and emerging treatment considerations.

Managing hypertension is a complex undertaking, where even the definition of the disorder is subject to discussion. Recently, there has been controversy concerning the most appropriate measure to determine health risks associated with hypertension. In the past, diastolic blood pressure (DBP) was the prime measure for defining hypertension, but currently systolic blood pressure (SBP) and pulse pressure have gained favor. Evidence now suggests that all three measures should be considered as part of the hypertensive profile, with the patient's age determining the relative importance of each. Aggressive treatment of hypertension may reduce morbidity and mortality. Data from trials clearly indicate that, for all stages of hypertension, the goal should be a maximum SBP of <150 mm Hg and a DBP of <90 mm Hg, with DBP values as low as 70 mm Hg being safe. For individuals with diabetes mellitus, these target values should be even lower--SBP <140 mm Hg and DBP <80 mm Hg. As a significant number of deaths attributable to hypertension occur in patients who are not diagnosed as hypertensive but whose blood pressure (BP) is above the optimal level of 120/80 mm Hg, lowering BP levels in this group is recommended as well, with lifestyle modification being first-line therapy. Because controlling BP to <140/90 mm Hg often requires the use of two or three agents, the tolerability of the entire regimen must be considered. However, with the multitude of antihypertensive drugs currently available, no patient's BP should remain above the 150/90 mm Hg level.