Systemic hypertension: an endemic, epidemic, and a pandemic.

Disease epidemics have influenced world history throughout time. Although disease patterns such as the plague and smallpox historically have been infectious in nature, chronic diseases such as cardiovascular disease, stroke, congestive heart failure, and end-stage renal disease have become the new global epidemics. The effects of these conditions affect nearly all populations of the world. Although high blood pressure has been implicated as the common link of these pandemic patterns only for less than half a century, the impact of hypertension treatment and control has become a documented population-based response with the greatest potential for global impact. For example, an estimated 45% of the deaths among African-American men could be prevented with treatment of high blood pressure to goal level. However, population demographics and risk factors predict a worsening effect as the populations of the world increase in age, racial disparities in access to medical care widen, and comorbid conditions such as obesity and metabolic syndrome continue to increase at epidemic rates. The economic impact of hypertension-related conditions, end-stage renal disease, and congestive heart failure is staggering, such that health care delivery systems will fail if the current trends are not changed. Hospitalization rates of hypertension-related conditions are increasing along with an aging population. The number of at-risk individuals in the population also is increasing. As the definition of hypertension changes with lower levels of blood pressure, the proportion of the population considered to have hypertension increases substantially. These trends and disease patterns clearly identify the essential need to implement population and clinical strategies for high blood pressure prevention, treatment, and control.