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Hypertension: Classification, Pathophysiology, and Management During Outpatient Sedation and Local Anesthesia

      Hypertension is defined as a systolic blood pressure (SBP) higher than 140 mHg or a diastolic blood pressure (DBP) higher than 90 mmHg; the diagnosis is based on the average of 2 or more readings taken at each of 2 or more visits after an initial screening.
      • Carter B.L.
      Highlights of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
      When determined by these criteria, hypertension affects 20% to 30% of the adult population in most developed countries, and its prevalence appears to increase with the age of the patient.
      • Brown M.J.
      • Haydock S.
      Pathoaetiology, epidemiology and diagnosis of hypertension.
      • Pardell H.
      • Tresserras R.
      • Armario P.
      • et al.
      Pharmacoeconomic considerations in management of hypertension.
      • Schoen F.J.
      Blood vessels.
      Recent publications have shown that the lifetime risk of hypertension for patients who are normotensive at age 55 is 90%.
      African Americans are affected by hypertension nearly twice as often as whites and seem to be more vulnerable to its complications.
      • Schoen F.J.
      Blood vessels.
      • Ashaye M.O.
      • Giles W.H.
      Hypertension in blacks A literature review.
      Hypertension is an important risk factor for cardiovascular accidents, coronary heart disease, cardiac hypertrophy with heart failure (hypertensive heart disease), aortic dissection, and renal failure. Hypertension can also accelerate atherogenesis and can induce changes favorable for aortic dissection and cerebrovascular hemorrhage.
      • Burt V.L.
      • Cutler J.A.
      • Higgins M.
      • et al.
      Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population data from the Health Examination Surveys, 1960 to 1991.
      Despite the prevalence of hypertension and its associated complications, only 29% of patients with hypertension are treated, and only 45% of those treated with antihypertensive medications have controlled disease.
      • Burt V.L.
      • Cutler J.A.
      • Higgins M.
      • et al.
      Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population data from the Health Examination Surveys, 1960 to 1991.
      • Pickering T.G.
      Optimal blood pressure levels.
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