Hypertension Medicine (Current Clinical Practice)

COVER......Page 1
FOREWORD......Page 6
PREFACE......Page 8
CONTRIBUTORS......Page 14
CONTENTS......Page 10
PART I. BACKGROUND ISSUES IN HYPERTENSION......Page 17
1. Studies Justifying the Use of Treatment to Prevent Cardiovascular Events......Page 19
WHETHER TO TREAT YOUNGER PERSONS WITH DIASTOLIC HYPERTENSION......Page 20
WHETHER TO TREAT OLDER PERSONS WITH HYPERTENSION......Page 21
WHAT OUR GOAL SHOULD BE FOR ANTIHYPERTENSIVE THERAPY......Page 23
WHICH DRUGS OR DRUG REGIMEN TO USE TO TREAT HYPERTENSION......Page 26
WHICH DRUGS TO USE IN SUBGROUPS OF HYPERTENSIVE PATIENTS......Page 27
WHAT CLINICAL TRIALS CURRENTLY IN PROGRESS WILL TELL US......Page 31
REFERENCES......Page 32
DEMOGRAPHY......Page 37
SYSTOLIC HYPERTENSION......Page 38
ALTERED CARDIOVASCULAR FUNCTIONS WITH AGE: CAUSES OF HYPERTENSION......Page 39
ADDITIONAL MEDICAL CONCERNS IN SENIOR HYPERTENSIVE PATIENTS......Page 40
THERAPEUTIC CONCERNS IN SENIOR HYPERTENSIVE PATIENTS......Page 41
REFERENCES......Page 42
3. Effects of Race on Blood Pressure......Page 43
PHYSIOLOGICAL PROFILE......Page 44
GENERAL THERAPEUTIC PRINCIPLES......Page 45
THERAPEUTIC TARGETS......Page 46
PREFERRED DRUG THERAPIES......Page 47
SUGGESTED READINGS......Page 48
4. Genetics in Hypertension......Page 49
LIPIDS IN THE HYPERTENSION SYNDROME......Page 50
LEFT VENTRICULAR HYPERTROPHY......Page 51
VENTRICULAR AND ARTERIAL COMPLIANCE......Page 52
ABNORMAL GLUCOSE AND INSULIN METABOLISM......Page 53
ENDOCRINE CHANGES......Page 56
NORMOTENSIVE SUBJECTS WITH HYPERTENSION SYNDROME VS HYPERTENSIVE SUBJECTS......Page 57
REFERENCES......Page 59
5. Sodium and Other Dietary Factors......Page 63
SALT (SODIUM CHLORIDE)......Page 64
POTASSIUM......Page 66
CALCIUM......Page 67
COMBINATION DIETS......Page 68
REFERENCES......Page 69
6. Role of Stress in Development of Hypertension......Page 71
ENVIRONMENTAL SOURCES OF PSYCHOLOGIC STRESS......Page 73
INDIVIDUAL PSYCHOLOGIC FACTORS AND PERCEPTION OF STRESS......Page 83
INDIVIDUAL DIFFERENCES IN SUSCEPTIBILITY TO PSYCHOLOGIC FACTORS......Page 86
PHYSIOLOGIC MECHANISMS THAT MIGHT MEDIATE STRESS-INDUCED HYPERTENSION......Page 91
CONCLUSION......Page 96
REFERENCES......Page 97
7. Neuroendocrine Factors......Page 105
CHANGING PHENOTYPE OF SYMPATHETIC OVERACTIVITY IN HYPERTENSION......Page 106
SYMPATHETIC OVERACTIVITY AND CORONARY RISK IN HYPERTENSION......Page 108
IMPLICATIONS FOR PRACTICE......Page 111
REFERENCES......Page 112
8. Left Ventricular Hypertrophy and Diastolic Dysfunction......Page 115
EPIDEMIOLOGY OF HYPERTENSIVE CARDIAC HYPERTROPHY......Page 116
PATHOPHYSIOLOGY OF LVH......Page 117
ADVERSE CONSEQUENCES OF LVH......Page 118
LEFT VENTRICULAR MASS, HYPERTENSION, AND DIASTOLIC DYSFUNCTION......Page 119
DETECTION OF LVH AND DIASTOLIC DYSFUNCTION......Page 120
REGRESSION OF LVH AND OUTCOME......Page 122
ROLE OF LVH AND DIASTOLIC DYSFUNCTION IN HEART FAILURE......Page 123
REFERENCES......Page 124
VASOACTIVE HORMONES......Page 127
DIABETES AND HYPERTENSION......Page 132
REFERENCES......Page 133
PART II. DIAGNOSIS AND SPECIAL TESTS......Page 135
10. Systolic, Diastolic, Mean, or Pulse Pressure......Page 137
HOW DO HEMODYNAMIC MECHANISMS IMPACT BP COMPONENTS?......Page 138
IMPORTANCE OF PULSE WAVE PROPAGATION AND REFLECTION......Page 139
WHICH BP COMPONENT IS THE BEST PREDICTOR OF PVR, LARGE-ARTERY STIFFNESS, AND HYPERTENSIVE CARDIOVASCULAR RISK?......Page 142
TREATMENT GOALS......Page 144
SUGGESTED READINGS......Page 145
11. Manual Blood Pressure Measurement—Still the Gold Standard......Page 147
OBSERVER ERRORS: CORRECT INTERPRETATION OF KOROTKOFF SOUNDS......Page 149
RECOMMENDATIONS/ALERTS......Page 150
OBSERVER ERRORS: FAILURE TO OBTAIN READINGS THAT ESTIMATE BP OUTSIDE THE OFFICE OR CLINICAL SETTING......Page 154
ENSURING THAT THE EQUIPMENT USED BY YOU AND YOUR PATIENTS IS ACCURATE......Page 157
HOME BPs BY THE PATIENT OR ANOTHER PERSON......Page 159
REFERENCES......Page 160
12. Initial Routine Tests for Diagnosis and Risk Stratification of the Patient with Hypertension......Page 163
ESSENTIAL VS SECONDARY HYPERTENSION......Page 164
ASSESSMENT OF TARGET ORGAN DAMAGE (TOD)......Page 166
EVALUATION OF OTHER CARDIOVASCULAR RISK FACTORS......Page 169
RESISTANT ARTERIAL HYPERTENSION......Page 170
SUGGESTED READINGS......Page 171
13. When to Suspect Secondary Hypertension......Page 173
COARCTATION OF THE AORTA......Page 174
PHEOCHROMOCYTOMA......Page 175
RENOVASCULAR DISEASE......Page 176
RENAL PARENCHYMAL DISEASE......Page 177
CONCLUSION......Page 178
REFERENCES......Page 181
GLOMERULAR FILTRATION RATE......Page 183
EVALUATION OF THE KIDNEY’S ABILITY TO DILUTE AND CONCENTRATE URINE......Page 187
CLINICAL ASSESSMENT OF RENAL ACIDIFICATION......Page 190
EVALUATION OF PROTEINURIA......Page 192
REFERENCES......Page 194
15. Ambulatory Blood Pressure Monitoring......Page 197
INSTRUCTIONS FOR THE PATIENT......Page 198
WHEN SHOULD AMBULATORY BP MONITORING BE CONSIDERED?......Page 199
AN APPROACH TO INTERPRETING AMBULATORY BP RESULTS......Page 201
REFERENCES......Page 204
16. Arterial Compliance in Hypertension......Page 207
THE ARTERIAL CIRCULATION AND ARTERIAL COMPLIANCE......Page 208
BLOOD PRESSURE AND ARTERIAL COMPLIANCE......Page 212
REFERENCES......Page 214
PART III. PRINCIPLES OF TREATMENT......Page 215
17. Starting Hypertension Treatment......Page 217
ARE LIFESTYLE MODIFICATIONS WORTH PURSUING?......Page 219
BP TARGETS......Page 221
HOW WELL IS BP BEING CONTROLLED?......Page 222
REFERENCES......Page 223
18. Choosing the First Agent......Page 225
CONSIDERATIONS FOR INITIAL THERAPY IN OLDER PATIENTS (TABLE 1)......Page 227
CONSIDERATIONS FOR INITIAL THERAPY BASED ON GENDER (TABLE 2)......Page 228
CONSIDERATIONS FOR INITIAL THERAPY IN AFRICAN-AMERICAN PATIENTS (TABLE 3)......Page 230
CONSIDERATIONS FOR INITIAL THERAPY IN OBESE HYPERTENSIVE PATIENTS......Page 231
CONSIDERATIONS FOR INITIAL THERAPY IN PATIENTS WITH HEART DISEASE......Page 232
CONSIDERATIONS FOR INITIAL THERAPY IN PATIENTS WITH RENAL DISEASE (TABLE 6)......Page 233
CONCLUSION......Page 235
REFERENCES......Page 236
PRELIMINARY CONSIDERATIONS......Page 239
CHANGING THE DRUG......Page 242
ADDING DRUGS......Page 243
REFERENCES......Page 245
20. Rationale for Low-Dose Combination Therapy in Cardiovascular Risk Management......Page 247
REASONS FOR INADEQUATE BP CONTROL......Page 248
RATIONALE FOR THE STEPPED-CARE APPROACH......Page 251
BENEFITS OF LOW-DOSE COMBINATION THERAPY......Page 252
COST OF TREATING HYPERTENSION......Page 255
OUTCOME DATA......Page 256
LOW-DOSE COMBINATION DRUG ARMAMENTARIUM......Page 257
REFERENCES......Page 258
21. How to Monitor Progress in Hypertensive Patients......Page 261
CONFIRMATION OF HYPERTENSION AND DETERMINATION OF SEVERITY......Page 262
FOLLOW-UP......Page 264
MONITORING ADEQUACY OF BP CONTROL......Page 265
MONITORING LABORATORY PARAMETERS......Page 267
MONITORING COMPLIANCE, ADVERSE EFFECTS, ASSOCIATED RISK FACTORS, AND TOD......Page 268
REFERENCES......Page 270
22. Problems of Treatment Compliance and Polypharmacy......Page 271
PREVENTION OF TREATMENT NONCOMPLIANCE......Page 272
DIAGNOSING AND DEALING WITH SUSPECTED TREATMENT NONCOMPLIANCE......Page 275
POLYPHARMACY......Page 276
REFERENCES......Page 277
INITIAL CHOICE OF MONOTHERAPY......Page 281
TWO- AND THREE-DRUG THERAPY......Page 283
COMPELLING CLINICAL INDICATIONS......Page 286
REFERENCES......Page 287
24. the Benefits of Antihypertensive Treatment......Page 291
SHORT-TERM OUTCOMES......Page 292
INTERMEDIATE-TERM OUTCOMES......Page 294
LONG-TERM OUTCOMES......Page 296
REFERENCES......Page 297
PART IV. MAJOR HYPERTENSIVE DRUG CLASSES......Page 299
25. Diuretics in Hypertension Therapy......Page 301
REFERENCES......Page 304
26. b-Adrenergic Blocker Treatment of Hypertension......Page 305
-BLOCKADE......Page 306
RENIN-ANGIOTENSIN SYSTEM AND BP HOMEOSTASIS......Page 308
-BLOCKADE AND RENIN SYSTEM ACTIVITY: RELATIONSHIP TO ANTIHYPERTENSIVE EFFICACY......Page 311
-BLOCKADE AND PREVENTION AND TREATMENT OF ACUTE MYOCARDIAL INFARCTION......Page 313
SUMMARY......Page 314
REFERENCES......Page 315
27. Calcium Antagonists......Page 317
CLINICAL PHARMACOLOGY......Page 318
CARDIAC CONTRACTILITY AND HYPERTROPHY......Page 320
CORONARY BLOOD FLOW AND MYOCARDIAL ISCHEMIA......Page 321
CLINICAL USE OF CALCIUM ANTAGONISTS IN HYPERTENSION......Page 322
CLINICAL USE OF CALCIUM ANTAGONISTS IN HYPERTENSIVE PATIENTS WITH DIABETES......Page 323
CONCLUSION......Page 326
REFERENCES......Page 327
28. Angiotensin-Converting Enzyme Inhibitors......Page 331
ANGIOTENSIN- AND BRADYKININ-MEDIATED ACTIONS......Page 332
CLINICAL EXPERIENCE WITH ACE INHIBITORS......Page 336
REFERENCES......Page 339
29. Angiotensin II Receptor Blockers......Page 341
Ang II RECEPTORS......Page 342
SIDE EFFECTS......Page 344
ARBs VS ACE INHIBITORS......Page 345
SUGGESTED READINGS......Page 346
-RECEPTOR PHYSIOLOGY AND BLOCKADE......Page 349
EFFECTS ON POSTURAL HOMEOSTASIS......Page 350
OTHER CLINICAL EFFECTS......Page 351
PHARMACODYNAMIC INTERACTIONS......Page 352
RATIONAL CLINICAL USE......Page 353
REFERENCES......Page 354
31. Centrally Acting Antihypertensive Drugs......Page 355
HEMODYNAMIC EFFECTS......Page 356
CLINICAL USE......Page 357
PART V. SOLVING PROBLEMS IN HYPERTENSION MANAGEMENT......Page 365
32 The National Health and Nutrition Examination Survey III......Page 367
STRATEGIES FOR ENHANCING AWARENESS OF HYPERTENSION......Page 368
STRATEGIES FOR ENHANCING ADHERENCE TO ANTIHYPERTENSIVE TREATMENT......Page 370
STRATEGIES FOR IMPROVING BP CONTROL......Page 375
COMORBID CONDITIONS......Page 379
REFERENCES......Page 381
33 Lipid Abnormalities and Hypertension......Page 383
LIPID ABNORMALITIES IN HYPERTENSIONWITH AND WITHOUT PREVIOUS CARDIOVASCULAR DISEASE......Page 385
DIABETES MELLITUS AND SYNDROME X......Page 388
SUGGESTED READINGS......Page 389
34 Diabetes and Hypertension......Page 391
ENDOTHELIAL DYSFUNCTION IN DIABETES AND HYPERTENSION......Page 393
EVALUATION AND TREATMENT OF HYPERTENSION IN ASSOCIATION WITH DIABETES MELLITUS......Page 394
REFERENCES......Page 396
35 Treatment of Hypertensive Patients with Chronic Renal Insufficiency......Page 399
PHARMACOLOGIC THERAPY: DIURETICS......Page 400
HYPERTENSIVE NEPHROSCLEROSIS AND CRI......Page 401
PROGRESSION OF CRI OF DIVERSE ETIOLOGIES......Page 402
ARE THERE RENOPROTECTIVE ANTIHYPERTENSIVE DRUGS?......Page 404
REFERENCES......Page 406
36 Treating Angina Pectoris in Hypertension......Page 411
ANTIPLATELET AGENTS AND ANTICOAGULANT THERAPY......Page 412
b-BLOCKERS......Page 413
CALCIUM CHANNEL BLOCKERS......Page 414
REVASCULARIZATION......Page 415
REFERENCES......Page 416
DEGENERATIVE JOINT DISEASE......Page 419
DEPRESSION......Page 421
ALZHEIMER DISEASE......Page 423
DEMENTIA OR NORMAL AGING?......Page 427
MRS. B: A COMMON PATIENT......Page 428
ALZHEIMER DISEASE AND VASCULAR DEMENTIA......Page 429
DIAGNOSIS OF DEMENTIA AT THE FAMILY PHYSICIAN’S OFFICE......Page 430
HOW TO TREAT HYPERTENSION IN DEMENTIA......Page 431
ASSESSMENT AND DIAGNOSIS......Page 432
CONCLUSION......Page 433
REFERENCES......Page 434
39 Refractory Hypertension......Page 435
PSEUDORESISTANCE......Page 436
DRUG-RELATED REASONS FOR REFRACTORY HYPERTENSION......Page 438
CONCOMITANT CONDITIONS......Page 439
EVALUATION AND ASSESSMENT......Page 440
CONCLUSION......Page 442
REFERENCES......Page 443
40 Hypertensive Emergencies......Page 445
DRUG THERAPY FOR HYPERTENSIVE EMERGENCIES......Page 446
CONSIDERATION OF CONCURRENT MEDICAL EMERGENCIES ACCOMPANYING SEVERE HYPERTENSION......Page 449
REFERENCES......Page 451
41 Referring to Hypertension Experts......Page 453
RATIONALE FOR HYPERTENSION CONSULTATIONS......Page 454
WHAT SHOULD THE HYPERTENSION CONSULTATION CONSIST OF?......Page 455
HYPERTENSION EXPERTS AS “POPULATION DOCTORS”......Page 460
REFERENCES......Page 461
A......Page 463
C......Page 465
D......Page 467
E......Page 468
H......Page 469
L......Page 470
N......Page 471
P......Page 472
R......Page 473
S......Page 475
T......Page 476
V......Page 477