Hypertension 1996 : One Medicine, Two Cultures
Life expectancy’s reduction in hypertensives
A. Menotti
Associazione per la Ricerca Cardiologica, Rome
Division of Epidemiology, University of Minnesota, Minneapolis MN, USA.
In epidemiology, arterial hypertension
is not considered a disease, but just an extreme deviation towards a biological
variable’s high levels, blood pressure, that is distributed not very differently
from the Gaussian curve.
It justifies all the doubts, the arbitrary and the simple conventionality
in the definition of the levels that separate the “normal” values from the
abnormal ones.
The main observational epidemiological acquisition on blood pressure and
on the arterial hypertension, consists in the direct and continuous relationship’s
demonstration between the blood pressure level, in the adults, an the risk
to go towards fatal and non fatal events, pertaining the coronary cardiopathy,
the strokes, the cardiovascular diseases, the mortality due to any cause,
and in some studies also the mortality for tumours and for violent death.
This observation has been confirmed in many studies, conducted in many countries,
also in Italy. Such association leads to a decrease of life expectancy that
is linked to every successive higher blood pressure level. “Spontaneous”
long-term variations of the blood pressure are followed by a different risk
to have morbid and lethal complications, mentioned above. Generally, blood
pressure increments are associated to an excess of risk and vice-versa.
The direct relationships between the blood pressure and the future events,
both observational simple, and linked to the variations of the arterial
pressure, have some exceptions. Particularly, the presence of very low values
of the blood pressure, for example, lower than 100 mmHg of systolic pressure,
especially if associated to a pathological status induce an excessive risk.
Furthermore, it seems that in old subjects, especially after the age of
75 years, the blood pressure values, associated with the increased longevity,
are not very low, and they often are higher than expected. But, also in
this case, the lower values are often associated to the presence of the
morbid conditions.
Edited by Aldo Campana,