Public health aspects of blood pressure

Although the age-specific mortality rates from cardiovascular diseases (CVD) are decreasing, CVD are still the number one cause of death in the Netherlands, with yearly over 50,000 deaths from these diseases.1 The most important CVD are coronary heart disease (CHD) and cerebrovascular accidents (CVA). In 1999, CHD constituted 36% (n=18,304), and CVA 25% (n=12,501) of total CVD deaths in the Netherlands. One of the major risk factors for CVD in general and for CVA in particular is elevated blood pressure. Until recently, elevated blood pressure or hypertension was defined as a systolic blood presssure (SBP) of 160 mmHg or greater and/or a diastolic blood pressure (DBP) of 95 mmHg or greater3 In the Netherlands, the prevalence of hypertension according to this definition was 9.2% in men and 7.1% in women aged 20-59 years from 1993 to 1995. The prevalence of hypertension increases with age. Among Dutch men and women aged 55 years and over living in Rotterdam, 22.6% respectively 27.1% had systolic or diastolic blood pressure levels of 160/95 mmHg from 1990 to 19934 Recently the WHO classification was revised and the threshold for hypertension was lowered to 140/90 mmHg. However every threshold is arbitrary, as results from most large observational studies have demonstrated that there is no clear threshold below which a lower level of blood pressure is not associated with a lower risk of CHD or CVA.

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