A new diagnostic classification for hypertension.

Abstract

Many epidemiologic studies have shown that the risks associated with high blood pressure are considerably greater in those with target-organ damage and other risk factors. Clinical trials also have shown that although lowering blood pressure decreases the incidence of premature cardiovascular diseases, those with target-organ damage and other cardiovascular risk factors benefit considerably more than those with comparable levels of blood pressure who are free of complications or additional risk factors. The classification schemes currently in use for hypertension, which are based only on the level of blood pressure, provide inadequate risk stratification, can be misleading, and may lead to making erroneous therapeutic decisions. We propose a new diagnostic classification for hypertension that combines the level of blood pressure with the presence of other risk factors for premature cardiovascular events and target-organ damage in order to provide a more accurate risk assessment and offer superior guidance for therapeutic decisions. This scheme includes a new category for the elderly with elevated systolic blood pressure, who we now know have excessive morbidity and mortality rates if their diastolic blood pressure is low. Our new classification scheme is simple to use and yet comprehensive, and we feel it provides better risk stratification and is a better guide to therapeutic decision-making than those now in use.