10 20 30 40 50 60

High BP

CAD

CHF

Stroke

Other

50,000,000

12,200,000

4,600,000

4,400,000

2,800,000

Prevalence (millions)

BP=blood pressure, CAD=coronary artery disease, CHF=congestive heart failure

American Heart Association® . 2000 Heart and Stroke Statistical Update. 1999.

(24%)

Eyes• Retinopathy

Kidneys• Nephropathy

Vasculature• Peripheral arterial

disease

Cerebral• Stroke• Transient ischemic

attack

Heart Disease• Angina• Myocardial infarction• Left ventricular

hypertrophy• Heart failure• Coronary revascularization

From Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997;157:2413-2446.

Sustaining a 12 mmHg reduction in SBP over 10 years will prevent one death for every 11 patients treated with Stage I HTN with additional CVD risk factors

Why treat hypertension?

◦ 35-40% in stroke morbidity and mortality

◦ 20-25% CAD events

◦ 21% vascular mortality

◦ 52% in CHF

◦ 35% in LVH

CountryDiagnosed

HypertensiveAware Treated Controlled

US 24% 42% 52% 24%

UK 19% 63% 50% 30%

France 41% 79% 59% 24%

Germany 53% 12% 32% 22%

Canada 22% 59% 40% 16%

Italy 58% 79% 51% 19%

China 14% 26% 12% 3%

Chockalingam, Am J Hypertens, 1998; Chamontin et al, Am J Hypertens, 1998; Marques-Vidal et al, Q J Med, 1997; Trenkwalder et al, J Hypertens, 1994; Vincenzi et al, G Ital Cardiol, 1992; Colhoun et al, J Hypertens, 1998; Franklin et al, Hypertension, 2001; Tao et al, Chin Med J, 1995.

BisoprololBloqueante beta-adrenérgico altamente cardioselectivo, con acción receptores β-1 .Escasa afinidad por los receptores β-2 de lamusculatura lisa bronquial y vascular, así como por los receptores β-2 implicados en laregulación metabólica.

USADA guide to prohibited classes of substances and prohibited methods of doping. Retrieved October 2001, from http://www.usantidoping.org/prohibited_sub/guide.asp.

Lancet. 2005;366:1545-53.

Age under 55 years

Aged over 55 years orblack person of African

or Caribbean familyorigin of any age

A C

A + C

A + C + D

Resistant hypertensionA + C + D + consider further

diuretic or alpha- orbeta-blocker

Consider seeking expert advice

KeyA – ACEI orARBC – CCBD – Thiazide like diuretic

Hypertension

Volume 59(4):893-898

March 14, 2012

Risk/Benefit Assessment of β-Blockers

and Diuretics Precludes Their Use for

First-Line Therapy in Hypertension

by Franz H. Messerli, Sripal Bangalore, and Stevo Julius

Circulation

Volume 117(20):2706-2715

May 20, 2008

Copyright © American Heart Association

Figure 6. Risk of new-onset diabetes

mellitus with antihypertensive treatment.

Messerli F et al. Circulation 2008;117:2706-2715

Copyright © American Heart Association

ARCH INTERN MED/VOL 170 (NO. 10), MAY 24, 2010

Ankle-brachial index in the 2 treatment groups at baseline

and after the 48 week treatment period.

Espinola-Klein C et al. Hypertension 2011;58:148-154

Copyright © American Heart Association