Essential Hypertension

The main purpose of this book is to select and present the most essential information about hypertension. It aims to select all the more relevant data to guide the attitudes to prevent, diagnose, and treat hypertension. Hypertension accounts for more than 50% of deaths from stroke and ischemic heart disease worldwide. New blood pressure (BP) diagnostic thresholds for hypertension were released, which were set at 130/80 mmHg. As a consequence, millions of individuals in the world will be diagnosed as hypertensive, recognizing that they are at greater risk of presenting a CV event. Prevention and control of high BP will become the main focus for reducing the burden of CV disease, requiring a changing of cultural beliefs in some way similar to what happened in the last century with smoking. Strategies for prevention of the rising of BP with age, and the BP reduction in individuals already with high levels, are more complex than those related to smoking control. These strategies involve solid evidence to be implemented in populations. The extensive scientific literature dealing with hypertension and BP regulation is among the top dedicated to a single disease. The chapters and contents follow the clinical reasoning pathways. The characterization of the risks of high blood pressure is presented in the first chapter, discussing the evidence that led to changes in diagnostic thresholds and to the recommendations for maintaining BP within these limits in populations. Reasons for BP rising with age will follow, identifying the causes that must be fought to preventing the incidence of hypertension. Diagnosis of hypertension deserves a special chapter. The final chapter presents the fundamentals to select drug and non-drug therapies indicated in the prevention and controlling of high blood pressure.

Essential (primary) Hypertension is the most current, concise, and practical step-by-step guide to the diagnosis, evaluation, and treatment of hypertension. This book provides all the knowledge base needed to identify and manage patients with Hypertension. 60% of those over the age of 60 suffer from Hypertension, a disease which affects hundreds of millions of individuals worldwide. This book guides the reader to understanding, proper diagnosis treatment.

Hypertension remains a leading cause of disability and death worldwide. Self-monitoring of blood pressure by patients at home is currently recommended as a valuable tool for the diagnosis and management of hypertension. Unfortunately, in clinical practice, home blood pressure monitoring is often inadequately implemented, mostly due to the use of inaccurate devices and inappropriate methodologies. Thus, the potential of the method to improve the management of hypertension and cardiovascular disease prevention has not yet been exhausted. This volume presents the available evidence on home blood pressure monitoring, discusses its strengths and limitations, and presents strategies for its optimal implementation in clinical practice. Written by distinguished international experts, it offers a complete source of information and guide for practitioners and researchers dealing with the management of hypertension.

As the first primer on the effects of exercise on human hypertension, Effects of Exercise on Hypertension: From Cells to Physiological Systems provides the state-of-the-art effects of exercise on the many possible mechanisms underlying essential hypertension in humans. The book contains chapters by distinguished experts on the effects of exercise on physiological systems known to be involved in hypertension development and maintenance as well as less well known aspects of hypertension such as 24-hour ambulatory blood pressure profile and oxidative stress. An emerging area, the effects of resistance exercise training on blood pressure is also covered. A unique aspect of the book is that it covers the effects of exercise mimetics on vascular cell adaptations in order to begin to elucidate some of the cellular mechanisms that may underlie blood pressure reductions with exercise training. Lastly, the book will end with a chapter on the interactive effects of genes and exercise on blood pressure. Chapters are grouped by physiological system or mechanism. The text begins with two overview chapters; one on the general effects of aerobic exercise training and the second on the general effects of resistance exercise training on blood pressure. Each chapter begins with a bulleted list of key points. Effects of Exercise on Hypertension: From Cells to Physiological Systems will be of great value to professional individuals in cardiovascular medicine, the cardiovascular sciences, allied health care professionals, and medical and graduate students in the cardiovascular sciences and medicine.

This new account of the pathogenesis of essential hypertension (EH) represents a detailed analysis of the main components of the circulatory control system. The latter's properties resemble those of man-made adaptive control systems in which regulatory parameters are altered when operating conditions exceed certain limits, often through neural mechanisms. Inheritance of EH depends on both genes and environment. The high blood pressure (BP) genes have not yet been definitively identified, whilst the main environmental causes are mental stress, high dietary salt intake and obesity. EH occurs as two major syndromes, each initiated by chronic stress: 1) Stress-and-salt related EH, and 2) Hypertensive obesity. Stress is perceived by the cortex, from which increased dopaminergic (DA) neuron activity stimulates the hypothalamic defense area, raising sympathetic neural activity (SNA) and BP. Normally these subside quickly when the stress is over, but in those susceptible to EH the DA synapses become sensitized so that the defense response is evoked by ever lower levels of stress. Sensitization is common in memory circuits, but not in autonomic neurons, so that this property in EH may be genetically determined. Stress-related hypertension increases hypothalamic responsiveness to high salt, resulting in further rises in SNA and BP. Later, non-neural functional changes (e.g. reduction in nitric oxide) and the structural remodeling of resistance vessels further enhance the vasoconstriction. In contrast, in those developing hypertensive obesity food consumption is excessive, which transiently alleviates stress-related anxiety. The brain ignores the leptin-mediated signals that normally curb appetite, contrasting with normal energy regulation in SSR-EH. In hypertensive obesity, the SNA pattern is similar to that in SSR-EH, but vasoconstriction is masked by vasodilatation and fluid retention due to hyperinsulinemia. This syndrome is a volume overload hypertension, where high cardiac output, renal impairment and other non-neural factors contribute to the elevation of BP. Other topics include the role of various transmitters in autonomic regulation; the place of baroreflexes in the intact organism; why exercise training lowers resting BP; obstructive sleep apnea; non-pharmacological and drug treatment of EH; the role of the kidney in EH and in different types of renal hypertension and the pathogenesis of the Japanese spontaneously hypertensive rat, which provides a valuable animal model for EH. The work suggests that physiological systems analysis in a complex disorder like EH is a valuable tool for using the great advances in molecular biology to best advantage.

It is well known that cardiovascular events occur more frequently in the morning as blood pressure (BP) levels have been shown to increase during the period from night to early morning. In recent years, clinical research using ambulatory blood pressure monitoring (ABPM) or home BP monitoring has clarified that morning BP and BP surge are more closely related to the cardiovascular risk than clinical BP. This practical manual from field leading expert, Dr. Kazuomi Kario, reviews recent evidence on morning and nocturnal hypertension and the IT technologies physicians can use to support patients in home monitoring BP. Guidance on management via antihypertensive drugs is also discussed and with the aim of promoting perfect 24 hour BP control.