K Collins, S Gough, M Clancy

Screening for hypertension in the emergency department
Emerg Med J 2008; 25: 196-199 [Abstract] [Full text] [PDF]

oscarjolobe{at}yahoo.co.uk oscar,m jolobe

The statement that "frequency of hypertension is very low below [the age of 35]"(1) should be qualified by the caveat that hypertension is acknowledged to be underdiagnosed in children and adolscents(2), and that, over the past decade, blood pressure has, in fact, increased in those two age groups(3). Accordingly,if anything, we are in the middle of a demographic change in the prevalence of hypertension, with the potential prospect of earlier onset of end points such as stroke, coronary heart disease, and death,traditionally employed in trials of antihypertensive therapy in the over 50's. In anticipation of these demographic changes I would suggest that we follow the advice given by Bryan Williams that the end point of treatment should shift from prevention of clinical events such as those I have enumarated, to regression of earlier structural damage so as to prevent further evolution of vascular damage in younger patients(4). Such an aim would, of necessity, entail earlier recognition of hypertension and its precurseor, pre-hypertension, even in the under 35's. Preliminary studies have already established that, in subjects of mean age 57, who are either preypertensive or have hypertension controlled to levels below 140/90 mm Hg, early markers of cardiovascular damage can regress in response to angiotensin receptor blockade(5). This partially answers the key question raised by Bryan Williams regarding the potential benefits of such treatment in younger patients(4). In spite of the documentation of regression of markers of cardiovascular damage in prehypertensive subjects(5) the issue of long-term medication in this subgroup has, however, not been finally resolved. Nevertheless, once established, the diagnosis of prehypertension confers the opportunity to offer lifestyle advice including weight reduction, moderation in alcohol intake, low-salt diet, and regular exercise so as to retard the progression from prehypertension to fully fledged hypertension. For all these reasons recognition of hypertension, and its precursor, prehypertension, in adults aged < 35 remains a worthwhile aim. References (1) Collins K., Gough S., Clancy M Screening for hypertension in the emergency department Emergency Medicine Journal 2008:25:196-9 (2) Hansen ML., Gunn PW., Kaelber DC Underdiagnosis of hypertension in children and adolescents Journal of the American Medical Association 2007:298:874-9 (3) Muntner P., He J., Cutler JA., Wildman RP., Whelton PK Trends in blood pressure among children and adolescents Journal of the American Medical Association 2004:291:2107-13 (4) Williams B Hypertension in the young Preventing the evolution of disease versus prevention of clinical events Journal of the American College of Cardiology 2007:50:840-2 (5) Duprez DA., Florea ND., Jones K., Cohn JN Beneficial effects of valsartan in asymptomatic individuals with vascular or cardiac abnormalities Journal of the American College of Cardiology 2007:50:835-9