Hypertension in India--definition, prevalence and evaluation.

High blood pressure (BP) is an important cardiovascular risk factor. Hypertension experts still debate on the level of BP considered abnormal. The currently accepted dividing line is systolic BP > or = 140 mm Hg and/or diastolic BP > or = 90 mm Hg based on epidemiological and intervention studies. In India, hypertension has become a major health problem. Epidemiological studies show a steadily increasing trend in hypertension prevalence over the last 40 years, more in urban than in the rural areas. This is converse to findings reported from developed countries where there is a significant decrease in its prevalence. Objectives of clinical evaluation of hypertensive individual are: To establish that BP is elevated, to seek evidence for a causal or contributory factor which may influence management, to assess target organ involvement and to assess relevant factors which will influence the particular mode of treatment to be adopted. Proper measurement techniques are important for diagnosis of hypertension. Canadian Coalition Guidelines are important in this regard. A basic, simple screening programme is the most appropriate policy for investigating the majority of hypertensive patients. Assessment of target organ involvement is important and can be obtained from history, physical examination or investigations. Studies of hypertension in general population have shown that secondary hypertension with high BP is present in 1.1% to 5.7% of subjects. Investigating all the hypertensive patients for secondary hypertension is not cost-effective and should be guided by history and clinical examination.