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September 24, 1997, Vol 278, No. 12 >
ARTICLE | September 24, 1997

A 42-Year-Old Man With Hypertension FREE

Suzanne Oparil, MD
[+] Author Affiliations

This conference took place at the Medicine Grand Rounds of the Beth Israel Deaconess Medical Center, East Campus, Boston, Mass, on May 15, 1997.

Reprints: Erin E. Hartman, MS, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, 330 Brookline Ave, LY318, Boston, MA 02215.

Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.


JAMA. 1997;278(12):1015-1021. doi:10.1001/jama.1997.03550120075037
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Article
References

Dr Delbanco:  Mr J is a 42-year-old African-American man first diagnosed with hypertension when he was 28 years old. He is married, lives in an apartment in the inner city of Boston with his wife and child, and works in an accounting department. He has health insurance through a managed care plan.His family history for hypertension is striking. His father died at the age of 69 years of complications of hypertension, with multiple strokes and congestive heart failure. His mother died at age 55 years of complications of hypertension and congestive heart failure. His 6 siblings do not have hypertension, but 3 have asthma.After being found hypertensive, Mr J underwent an evaluation for secondary causes, including physical examination, urinalysis, electrolytes, serum urea nitrogen, creatinine, serum creatinine, and thyroid function tests; all findings were normal. He stopped smoking in 1991 after a 12 pack-year history and has not smoked

REFERENCES

1 +
Burt VL, Whelton P, Roccella EJ, et al.  Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988-1991 . Hypertension . 1995;;25:305-313.
2 +
National High BP Education Program Working Group.  Report on primary prevention of hypertension . Arch Intern Med . 1993;;153:186-208.
3 +
US Renal Data System. USRDS 1996 Annual Report. Bethesda, Md: US Dept of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases; 1996.
4 +
Klag M, Whelton P, Randall B, Neaton J, Brancati F, Stamler J.  End-stage renal disease in African-American and white men . JAMA . 1997;;277:1293-1298.
5 +
Ward R.  Familial aggregation and genetic epidemiology of BP . In: Laragh JH, Brenner BM, eds. Hypertension:Pathophysiology, Diagnosis, and Management, I . New York, NY: Raven Press; 1990;:81-100.
6 +
Oparil S, Calhoun DA. High BP. Sci Am Med. In press.
7 +
M'Buyamba-Kabangu JR, Amery A, Lijnen P.  Differences between black and white persons in BP and related biological variables . J Hum Hypertens . 1994;;8:163-170.
8 +
Bulpitt CJ.  BP and potassium consumption . In: Bulpitt CJ, ed. Handbook of Hypertension, Volume 6: Epidemiology of Hypertension . Amsterdam, the Netherlands: Elsevier Science Publishers; 1985;:291-305.
9 +
Langford HE, Langford FPJ, Tyler M.  Dietary profile of sodium and calcium in U.S. blacks . In: Hall WD, Saunders E, Shulman NB, eds. Hypertension in Blacks: Epidemiology, Pathophysiology and Treatment . Chicago, Ill: Year Book Medical Publishers; 1985;:49-57.
10 +
McCarron DA, Morris DA, Cole C.  Dietary calcium in human hypertension . Science . 1982;;217:267-269.
11 +
Campese VM, Prise M, Karubian F, Bigazzi R.  Abnormal renal hemodynamics in black and salt-sensitive patients with hypertension . Hypertension . 1991;;18:805-812.
12 +
Sudhir K, Forman A, Yi S-L, et al.  Reduced dietary potassium reversibly enhances vasopressor response to stress in African-Americans . Hypertension . 1997;;29:1083-1090.
13 +
Calhoun DA, Mutinga ML, Collins AS, Wyss JM, Oparil S.  Normotensive blacks have heightened sympathetic response to cold pressor test . Hypertension . 1993;;22:801-805.
14 +
Harburg E, Erfurt JC, Chape C, Hauenstein LS, Schull WJ, Schork MA.  Socioecological stressor areas and black-white BP: Detroit . J Chronic Dis . 1973;;26:595-611.
15 +
Keil JE, Tyroler HA, Sandifer SH, Boyle E.  Hypertension: effects of social class and racial admixture . Am J Public Health . 1977;;67:634-639.
16 +
Lindquist T, Beilin L, Knuiman M.  Influence of lifestyle, coping, and job stress on blood pressure in men and women . Hypertension . 1997;;29:1-7.
17 +
American Society of Hypertension.  Recommendations for routine blood pressure measurement by indirect cuff sphygmomanometry . Am J Hypertens . 1992;;5:207-209.
18 +
Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH.  How common is white coat hypertension? JAMA . 1988;;259:225-228.
19 +
Eisenberg DM, Delbanco TL, Berkey CS, et al.  Cognitive behavioral techniques for hypertension: are they effective? Ann Intern Med . 1993;;118:964-972.
20 +
The Trials of Hypertension Prevention Collaborative Research Group.  The Trials of Hypertension Prevention, Phase II . Arch Intern Med . 1997;;157:657-666.
21 +
NIH Consensus Development Panel on Physical Activity and Cardiovascular Health.  Physical activity and cardiovascular health . JAMA . 1996;;276:241-246.
22 +
McCarron DA, Oparil S, Chait A.  Nutritional management of cardiovascular risk factors: A randomized clinical trial . Arch Intern Med . 1997;;157:169-177.
23 +
Appel LJ, Moore TJ, Obarzanek E, et al, for the DASH Collaborative Research Group. The effect of dietary patterns on BP . N Engl J Med . 1997;;336:1117-1124.
24 +
Whelton P, He J, Cutler JA, et al.  Effects of oral potassium on blood pressure . JAMA . 1997;;277:1624-1632.
25 +
Midgley JP, Matthew AG, Greenwood CMT, Logan AG.  Effect of reduced dietary sodium on blood pressure . JAMA . 1996;;275:1590-1597.
26 +
Cutler JA, Follmann D, Allender PS.  Randomized trials of sodium reduction: an overview . Am J Clin Nutr . 1997;;65( (suppl 2) ):643S-651S.
27 +
Alderman MH, Madhavan S, Cohen H, Sealey JE, Laragh JH.  Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men . Hypertension . 1995;;25:1144-1152.
28 +
Joint National Committee.  The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) . Arch Intern Med . 1993;;153:154-183.
29 +
Epstein M, Bakris G.  Newer approaches to antihypertensive therapy: use of fixed-dose combination therapy . Arch Intern Med . 1996;;156:1969-1978.
30 +
Jones JK, Gorkin L, Lian JF, Staffa JA, Fletcher AP.  Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population . BMJ . 1995;;311:293-295.
31 +
Shea S, Misra D, Ehrlich MH, Field L, Francis CK.  Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population . N Engl J Med . 1992;;372:776-781.
32 +
Houston Miller N, Hill M, Kottke T, Ockene IS.  The multilevel compliance challenge . Circulation . 1997;;95:1085-1090.
33 +
Neaton JD, Grimm RH, Prineas RJ, et al, for the Treatment of Mild Hypertension Study Research Group.  Treatment of mild hypertension study: final results . JAMA . 1993;;270:713-724.
34 +
Materson BJ, Reda DJ, Cushman WC, et al, for the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents.  Single-drug therapy for hypertension in men . N Engl J Med . 1993;;328:914-921.
35 +
Materson BJ, Reda DJ, Cushman WC.  Department of Veterans Affairs single-drug therapy of hypertension study; revised figures and new data . Am J Hypertens . 1995;;8:189-192.
36 +
Grimm RH, Grandits GA, Prineas RJ, et al.  Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women . Hypertension . 1997;;29:8-14.
37 +
Jamerson K, DeQuattro V.  The impact of ethnicity on response to antihypertensive therapy . Am J Med . 1996;;101:22S-32S.
38 +
Oparil S.  Antihypertensive therapy and atherosclerosis in coronary heart disease . Cardiovasc Risk Factors . 1996;;6:222-232.
39 +
Davis BR, Cutler JA, Gordon DJ, et al, for the ALLHAT Research Group.  Rationale and design for the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) . Am J Hypertens . 1996;;9:342-360.
40 +
Psaty BM, Heckbert SR, Koepsell TD, et al.  The risk of myocardial infarction associated with antihypertensive drug therapies . JAMA . 1995;;274:620-625.
41 +
Pahor M, Guralnik JM, Furberg CD, Carbonin P, Havlik RJ.  Longterm survival and use of antihypertensive medication in older persons . J Am Geriatr Soc . 1995;;43:1191-1197.
42 +
Pahor M, Guralnik JM, Salive ME, Corti MC, Carbonin P, Havlik RJ.  Do calcium channel blockers increase the risk of cancer? Am J Hypertens . 1996;;9:695-699.
43 +
Pahor M, Guralnik JM, Furberg CD, Carbonin P, Havlik RJ.  Risk of gastrointestinal hemorrhage with calcium antagonists in hypertensive persons over 67 years old . Lancet . 1996;;347:1061-1065.
44 +
Braun S, Boyko V, Reicher-Reiss H, et al.  Calcium antagonists and mortality in patient . J Am Coll Cardiol . 1996;;27:7-11.
45 +
Jick H, Jick S, Derby LE, Vasilakis C, Myers MW, Meier CR.  Calcium-channel blockers and risk of cancer . Lancet . 1997;;349:525-528.
46 +
Alderman MH, Cohen H, Roque R, Madhavan S.  Effect of long-acting and short-acting calcium antagonists on cardiovascular outcomes in hypertensive patients . Lancet . 1997;;349:594-598.
47 +
Setaro JF, Black HR.  Refractory hypertension . N Engl J Med . 1992;;327:543-547.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Burt VL, Whelton P, Roccella EJ, et al.  Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988-1991 . Hypertension . 1995;;25:305-313.
2 +
National High BP Education Program Working Group.  Report on primary prevention of hypertension . Arch Intern Med . 1993;;153:186-208.
3 +
US Renal Data System. USRDS 1996 Annual Report. Bethesda, Md: US Dept of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases; 1996.
4 +
Klag M, Whelton P, Randall B, Neaton J, Brancati F, Stamler J.  End-stage renal disease in African-American and white men . JAMA . 1997;;277:1293-1298.
5 +
Ward R.  Familial aggregation and genetic epidemiology of BP . In: Laragh JH, Brenner BM, eds. Hypertension:Pathophysiology, Diagnosis, and Management, I . New York, NY: Raven Press; 1990;:81-100.
6 +
Oparil S, Calhoun DA. High BP. Sci Am Med. In press.
7 +
M'Buyamba-Kabangu JR, Amery A, Lijnen P.  Differences between black and white persons in BP and related biological variables . J Hum Hypertens . 1994;;8:163-170.
8 +
Bulpitt CJ.  BP and potassium consumption . In: Bulpitt CJ, ed. Handbook of Hypertension, Volume 6: Epidemiology of Hypertension . Amsterdam, the Netherlands: Elsevier Science Publishers; 1985;:291-305.
9 +
Langford HE, Langford FPJ, Tyler M.  Dietary profile of sodium and calcium in U.S. blacks . In: Hall WD, Saunders E, Shulman NB, eds. Hypertension in Blacks: Epidemiology, Pathophysiology and Treatment . Chicago, Ill: Year Book Medical Publishers; 1985;:49-57.
10 +
McCarron DA, Morris DA, Cole C.  Dietary calcium in human hypertension . Science . 1982;;217:267-269.
11 +
Campese VM, Prise M, Karubian F, Bigazzi R.  Abnormal renal hemodynamics in black and salt-sensitive patients with hypertension . Hypertension . 1991;;18:805-812.
12 +
Sudhir K, Forman A, Yi S-L, et al.  Reduced dietary potassium reversibly enhances vasopressor response to stress in African-Americans . Hypertension . 1997;;29:1083-1090.
13 +
Calhoun DA, Mutinga ML, Collins AS, Wyss JM, Oparil S.  Normotensive blacks have heightened sympathetic response to cold pressor test . Hypertension . 1993;;22:801-805.
14 +
Harburg E, Erfurt JC, Chape C, Hauenstein LS, Schull WJ, Schork MA.  Socioecological stressor areas and black-white BP: Detroit . J Chronic Dis . 1973;;26:595-611.
15 +
Keil JE, Tyroler HA, Sandifer SH, Boyle E.  Hypertension: effects of social class and racial admixture . Am J Public Health . 1977;;67:634-639.
16 +
Lindquist T, Beilin L, Knuiman M.  Influence of lifestyle, coping, and job stress on blood pressure in men and women . Hypertension . 1997;;29:1-7.
17 +
American Society of Hypertension.  Recommendations for routine blood pressure measurement by indirect cuff sphygmomanometry . Am J Hypertens . 1992;;5:207-209.
18 +
Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH.  How common is white coat hypertension? JAMA . 1988;;259:225-228.
19 +
Eisenberg DM, Delbanco TL, Berkey CS, et al.  Cognitive behavioral techniques for hypertension: are they effective? Ann Intern Med . 1993;;118:964-972.
20 +
The Trials of Hypertension Prevention Collaborative Research Group.  The Trials of Hypertension Prevention, Phase II . Arch Intern Med . 1997;;157:657-666.
21 +
NIH Consensus Development Panel on Physical Activity and Cardiovascular Health.  Physical activity and cardiovascular health . JAMA . 1996;;276:241-246.
22 +
McCarron DA, Oparil S, Chait A.  Nutritional management of cardiovascular risk factors: A randomized clinical trial . Arch Intern Med . 1997;;157:169-177.
23 +
Appel LJ, Moore TJ, Obarzanek E, et al, for the DASH Collaborative Research Group. The effect of dietary patterns on BP . N Engl J Med . 1997;;336:1117-1124.
24 +
Whelton P, He J, Cutler JA, et al.  Effects of oral potassium on blood pressure . JAMA . 1997;;277:1624-1632.
25 +
Midgley JP, Matthew AG, Greenwood CMT, Logan AG.  Effect of reduced dietary sodium on blood pressure . JAMA . 1996;;275:1590-1597.
26 +
Cutler JA, Follmann D, Allender PS.  Randomized trials of sodium reduction: an overview . Am J Clin Nutr . 1997;;65( (suppl 2) ):643S-651S.
27 +
Alderman MH, Madhavan S, Cohen H, Sealey JE, Laragh JH.  Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men . Hypertension . 1995;;25:1144-1152.
28 +
Joint National Committee.  The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) . Arch Intern Med . 1993;;153:154-183.
29 +
Epstein M, Bakris G.  Newer approaches to antihypertensive therapy: use of fixed-dose combination therapy . Arch Intern Med . 1996;;156:1969-1978.
30 +
Jones JK, Gorkin L, Lian JF, Staffa JA, Fletcher AP.  Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population . BMJ . 1995;;311:293-295.
31 +
Shea S, Misra D, Ehrlich MH, Field L, Francis CK.  Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population . N Engl J Med . 1992;;372:776-781.
32 +
Houston Miller N, Hill M, Kottke T, Ockene IS.  The multilevel compliance challenge . Circulation . 1997;;95:1085-1090.
33 +
Neaton JD, Grimm RH, Prineas RJ, et al, for the Treatment of Mild Hypertension Study Research Group.  Treatment of mild hypertension study: final results . JAMA . 1993;;270:713-724.
34 +
Materson BJ, Reda DJ, Cushman WC, et al, for the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents.  Single-drug therapy for hypertension in men . N Engl J Med . 1993;;328:914-921.
35 +
Materson BJ, Reda DJ, Cushman WC.  Department of Veterans Affairs single-drug therapy of hypertension study; revised figures and new data . Am J Hypertens . 1995;;8:189-192.
36 +
Grimm RH, Grandits GA, Prineas RJ, et al.  Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women . Hypertension . 1997;;29:8-14.
37 +
Jamerson K, DeQuattro V.  The impact of ethnicity on response to antihypertensive therapy . Am J Med . 1996;;101:22S-32S.
38 +
Oparil S.  Antihypertensive therapy and atherosclerosis in coronary heart disease . Cardiovasc Risk Factors . 1996;;6:222-232.
39 +
Davis BR, Cutler JA, Gordon DJ, et al, for the ALLHAT Research Group.  Rationale and design for the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) . Am J Hypertens . 1996;;9:342-360.
40 +
Psaty BM, Heckbert SR, Koepsell TD, et al.  The risk of myocardial infarction associated with antihypertensive drug therapies . JAMA . 1995;;274:620-625.
41 +
Pahor M, Guralnik JM, Furberg CD, Carbonin P, Havlik RJ.  Longterm survival and use of antihypertensive medication in older persons . J Am Geriatr Soc . 1995;;43:1191-1197.
42 +
Pahor M, Guralnik JM, Salive ME, Corti MC, Carbonin P, Havlik RJ.  Do calcium channel blockers increase the risk of cancer? Am J Hypertens . 1996;;9:695-699.
43 +
Pahor M, Guralnik JM, Furberg CD, Carbonin P, Havlik RJ.  Risk of gastrointestinal hemorrhage with calcium antagonists in hypertensive persons over 67 years old . Lancet . 1996;;347:1061-1065.
44 +
Braun S, Boyko V, Reicher-Reiss H, et al.  Calcium antagonists and mortality in patient . J Am Coll Cardiol . 1996;;27:7-11.
45 +
Jick H, Jick S, Derby LE, Vasilakis C, Myers MW, Meier CR.  Calcium-channel blockers and risk of cancer . Lancet . 1997;;349:525-528.
46 +
Alderman MH, Cohen H, Roque R, Madhavan S.  Effect of long-acting and short-acting calcium antagonists on cardiovascular outcomes in hypertensive patients . Lancet . 1997;;349:594-598.
47 +
Setaro JF, Black HR.  Refractory hypertension . N Engl J Med . 1992;;327:543-547.

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