CaRDio-ReNal CasCaDe iN hypeRTeNsive paTieNTs

smoking, dyslipidemia, and diabetes, the other major risk factors. The increase in risk begins as the blood pressure rises above 110/75 mm Hg (Fig. 1). In older patients, systolic pressure and perhaps pulse pressure are more powerful determinants of risk than diastolic pressure. While systolic pressure and pulse pressure are important risk factors, in our experience they are extremely difficult to treat. The cardiovascular disease manifests in the form of left ventricular hypertrophy, congestive heart failure, coronary vascular disease, stroke, and peripheral vascular disease. LVH is characterized by an increase in left ventricular mass. Hypertension may also cause interstitial fibrosis. Both factors result in an increase in left ventricular stiffness resulting in diastolic dysfunction and elevated end-diastolic pressure. Diastolic dysfunction may be further aggravated by ischemia due to coronary artery disease. This in turn is associated with an enhanced incidence of heart failure, ventricular arrhythmias, death following myocardial infarction, and sudden cardiac death. Atherosclerosis develops in the large and medium size arteries (carotid, coronary, renal and iliac) manifesting as stroke, ischemic heart disease, ischemic nephropathy, and claudicating pain while walking. Atherosclerotic carotid artery disease due to hypertension is the most common and most important stroke risk factor. Both prior and current blood pressure is important risk factors.