First Concepts.
WOB is Optimal
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.
http://en.wikipedia.org/wiki/Hypertension
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).
New paradigm
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
http://cme.staging.medscape.com/viewarticle/708548