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The heart and hypertension are intimately linked. Hypertension predisposes to coronary heart disease, myocardial hypertrophy, and cardiac dysfunction. Other organs and systems are also important in hypertension but this article concentrates on the effect of hypertension on the heart. The impact of hypertension on the heart is much more important than its effect in causing stroke and renal failure in terms of numbers of patients affected. There is still undue emphasis on diastolic pressure, with little attention paid to isolated systolic hypertension, and treatment remains inadequate for many patients. Cardiologists have a responsibility in this regard. The perspective taken in this article is that of the physician in the outpatient clinic.
General practitioners deal with most hypertension. Patients are usually sent to the hospital clinic because the blood pressure has not been controlled despite multiple drug treatment, for loss of previously good control, where it is felt that a cause for hypertension should be sought, or because of an overt cardiovascular event. The extent and tempo of investigation of the elevated pressure are determined by the clinical situation. Hypertension also presents as an incidental finding in other clinical situations and as a result is often suboptimally managed or even ignored. Attention to blood pressure is surprisingly cavalier in cardiac clinics given its importance as a risk factor. Undoubtedly, it is more difficult to deal with than the measurement of cholesterol and the reflex—albeit appropriate—prescribing of a statin in the patient with known ischaemic heart disease. In light of the cost of coronary angioplasty and bypass graft surgery, especially to the patient, it seems inappropriate not to pursue rigorously the best management of hypertension. Blood pressure recordings after myocardial infarction, revascularisation, and rest in hospital are unlikely to be representative of subsequent levels. Follow up is essential.
Even when undertaken, the …
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