Hypertension

Case presentation 1 : A morbidly obese but nonsmoking and nondiabetic 44-year-old African woman (body mass index, 41 kg/m2) presents with exertional dyspnea to a primary healthcare clinic in Soweto, adjacent to Johannesburg, South Africa. She seeks medical attention for the first time. Her blood pressure (BP) is 178/115 mm Hg, her total and high-density lipoprotein cholesterol are 2.6 and 0.9 mmol/L (100 and 34 mg/dL), respectively, and her heart rate is 112 bpm. Her initial absolute risk (Framingham algorithm) is calculated at 2% (low) probability of cardiovascular disease (CVD) within 5 years, increasing to 5% (high) when preliminary evidence of left ventricular hypertrophy is subsequently found on 12-lead ECG.Case presentation 2 : A 60-year-old, nondiabetic, Chinese woman (body mass index, 24 kg/m2) visits a primary healthcare clinic in Beijing, complaining about painful knees. A routine physical examination reveals a BP of 145/90 mm Hg, total and high-density lipoprotein cholesterol of 4.8 and 1.1 mmol/L (185.6 and 42.5 mg/dL), respectively, and heart rate of 72 bpm. Her absolute risk (initially) is calculated as 6% (low) probability of CVD within 5 years. Despite some nonspecific but abnormal ECG findings, she does not qualify as having “ECG evidence of left ventricular hypertrophy,” which would increase her absolute risk to 20% (high). However, the woman is questioned more carefully about potential risks, and she admits to smoking 15 cigarettes per day. Her recalculated risk is now 12% (intermediate) and would rise to 16% (high) if, by the age of 65 years, her systolic BP increased to 155/90 mm Hg.Case presentation 3 : A 65-year-old (nonsmoking) white woman (body mass index, 28 kg/m2) presents to a primary care clinic in Charlotte, NC, and is found to be hypertensive with a BP of 170/110 mm Hg and heart rate of …