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Worldwide, it is estimated that hypertension affected 972 million adults in 2000, and it was further predicted this would increase to 1.56 billion by 2025 (Kearney and colleagues, 2005). The prevalence of chronic hypertension in American women has been chronicled since 1960 by the National Center for Health Statistics (1964). The ongoing study—the National Health and Nutrition Examination Survey (NHANES)—still provides periodic information. The average prevalence of hypertension in women 18 to 39 years of age was 7.2 percent for the 1999–2000 biennium (Hajjar and Kotchen, 2003). This is a substantive increase when compared with 6 percent for the previous decade. Importantly, a third of these patients are unaware of their hypertension, and its importance in relation to women's healthcare was highlighted in the Clinical Update by the American College of Obstetricians and Gynecologists (2005).

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Chronic hypertension is also one of the most common medical complications encountered during pregnancy. For example, Podymow and August (2007) cite a 3-percent incidence from their review. Its variable incidence and severity, along with the well-known proclivity for pregnancy to induce or aggravate hypertension, has caused confusion concerning its management. Most women with antecedent hypertension demonstrate improved blood-pressure control during pregnancy. In others, however, there is worsening of hypertension that may be accompanied by proteinuria, symptoms, and convulsions. These latter women in whom hypertension antedates pregnancy are indistinguishable from an otherwise normotensive woman who develops preeclampsia in her first pregnancy.

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There is a wide range of blood pressures in normal adults as well as in those with chronic hypertension. Categorization therefore relates to acute or long-term adverse effects associated with sustained levels of those blood pressures. These associations with normal or abnormal blood pressures are primarily based on morbidity and mortality in men. A useful categorization is that provided by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. In its seventh report—JNC-7—the Joint National Committee (2003) used the classification and management scheme summarized in Table 45-1. A newly added significant change is the category termed prehypertension, which was intended to convey that cardiovascular risk begins to increase at levels of 115 mm Hg systolic and 75 mm Hg diastolic. Within each of these categories shown in Table 45-1, morbidity or mortality rates are further influenced by age, gender, race, and personal behaviors that include smoking, excessive alcohol, obesity, and physical activity.

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Table 45-1. Classification and Management of Blood Pressure for Adults

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