Until recently elevated blood pressure was regarded as a disease. About 90-95% of the patients have essential hypertension whose cause is unknown, and the rest carry secondary hypertension whose cause is known. Persistent hypertension is an important risk factor for a A paradigm shift in hypertension
Until recently elevated blood pressure was regarded as a disease. About
90-95% of the patients have essential hypertension whose cause is unknown,
and the rest carry secondary hypertension whose cause is known. Persistent
hypertension is an important risk factor for a progressive cardiovascular
syndrome (CVS), e.,g., stroke, heart failure, and arterial
aneurysm. Risk factor is a measure for the association between elevated
blood pressure (BP) and CVS.
This association was hitherto interpreted as a cause-effect relationship. It was taken that BP actually causes CVS, and in order to protect the patient, treatment ought to lower BP to its normal value. However this association was not perfect (100%). Some patients with elevated BP had no CVS, and others who had normal BP ultimately got it. Hypertension experts consider therefore elevated BP solely as a disease marker, rather than a cause of hypertension. Elevated BP should not therefore, be viewed or treated in isolation, but considered in the context of whole patient care, which takes into account the presence of other risk factors and disease markers for CVD (1).
In 2005, the Hypertension Writing Group (HWG) proposed a new definition of hypertension as "a progressive cardiovascular syndrome (CVS), the early markers of which may be present even before BP elevation is observed." BP serves as a bio-marker for the disease hypertension and, as such, elevated BP is not synonymous with hypertension. BP should be evaluated in the context of other CV risk factors and disease markers.
Blood glucose and tumor as disease markers
Let's turn our attention to other chronic diseases, like diabetes mellitus and cancer. In diabetes, organ failure is associated with elevated blood sugar. In cancer death is associated with the tumor. Both associations are interpreted as cause-effect relationships.
Yet the association is imperfect which suggests that blood glucose and tumor ought to be regarded solely as disease markers. Tumor and blood glucose should be evaluated in the context of other risk factors and disease markers.
There is more to cancer than just he tumor. Cancer is a triad consisting of a tumor, para-neoplasia and weight loss ending in cachexia.
1. Giles, TD
Rethinking Hypertension in the 21st Century: An Overview of the
Expanded Definition and Classification of Hypertension CME