The Nature Of Essential Hypertension

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.

In the last two decades, investigations at the cellular level have progressively gained ground in the context of hypertension research. This choice of approach is due to some extent to the build up of know-how that molecular and cellular biology have been producing at a continuous rate. As the contents list of this volume shows, a large mass of work has been directed to gaining some insight into pathogenetic mechanisms. The pathogenesis of primary hypertension has been progressively categorized as a distinct biological problem, not amenable to the theoretical models that proved successful in understanding the nature of secondary forms of hypertension. At the same time, great efforts have been made to simplify this problem by sorting out, if possible, a few crucial mechanisms from the network of contributory factors in the regulation of blood pressure. The idea that what is to be sought is a primary structural and/or functional fault in arterial muscle has met with widespread acceptance. The strength of this argument lies in the fact that peripheral vascular resistance is increased in all forms of hypertension and, in turn, the diameter of resistance vessels is the dominant factor in the computation of total per ipheral resistance. On the basis of this, cardiovascular structural adaptation was proposed as a positive feedback mechanism tending to maintain hypertension, once begun, whatever the initiating factor is.

This book identifies the key determinants in the management of hypertensive outpatients with Cardiac Target Organ Damage. It sheds light on current international guidelines by directly applying them to six representative clinical cases that reflect situations frequently encountered during clinical routine rather than emergencies or rare occurrences. The book enables cardiologists and angiologists alike to gain an overview of the most frequent cardiac dysfunctions related to hypertension: left atrial enlargement, aortic root dilatation, diastolic dysfunction, systolic dysfunction, left and right ventricular enlargement. Each case is illustrated and analyzed in detail – from family and personal history to treatment and follow-up – providing readers with valuable guidance that will help them to select the best suited diagnostic tool and treatment for each patient.

This book aims to present a comprehensive classification of hypertensive phenotypes based on underlying target organ involvement. Particular emphasis is placed on review and assessment of clinical presentation, pathophysiologic mechanisms, and possible specific therapeutic options for each hypertension phenotype. Several of these phenotypes are well known and well described in the literature, such as prehypertension, white coat and masked hypertension, isolated systolic hypertension, renovascular hypertension, endocrine hypertension, pediatric hypertension, and gestational hypertension. Other hypertension phenotypes, however, are not widely recognized, being reported only in special reviews; examples include hypertension associated with renal calculus disease and other rarer causes such as Turner syndrome, herbal and medicinal compounds, and pharmacologic agents. A detailed account of the various causes of monogenic hypertension is also included. Finally, a section is devoted to general aspects of hypertension, including the significance of blood pressure indices, the natural course of untreated and treated hypertension, hypertension mechanisms, genetics, and guidelines for blood pressure control.

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.