Strategies for Initial Management of Hypertension (Report‪)‬

Introduction High blood pressure (BP) is a major public health problem in India and elsewhere (1-4). It is a major cardiovascular risk factor (5-7) and contributes significantly to cardiovascular mortality (8,9). Prospective Studies Collaboration has reported that reducing BP can substantially decrease cardiovascular risk and cardiovascular as well as all-cause mortality (10). This risk reduction is steeper in younger subjects than in the older subjects (Fig.) and is more when baseline blood pressure levels are high. In a meta-analysis of 61 studies involving more than a million patients with hypertension and 12.7 million years of follow up it was observed that reducing systolic as well as diastolic BP reduced cardiovascular events (11). At ages 40-69 yr, each difference of 20 mm Hg systolic BP or 10 mm Hg diastolic BP was associated with more than a two-fold difference in the stroke death rate, and with two-fold differences in the death rates from coronary heart disease and other vascular causes. All of these proportional differences in vascular mortality were about half as extreme at ages 80-89 yr as at ages 4049 yr, but the annual absolute differences in risk were greater in old age.