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.

From the Council on High Blood Pressure Research. American Heart Association.

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.

Many of the nearly 70 million Americans with hypertension (high blood pressure) would like to bring it under control through lifestyle changes such as losing weight, cutting back on salt, exercising, or reducing stress. But, like it or not, most will require medication to get their blood pressure where it needs to be. The good news is that we have many excellent blood pressure medications which, when prescribed wisely, can control hypertension in almost everyone. The bad news is that, despite good intentions, doctors are placing millions of people who have hypertension on medications, drug combinations, or doses that are wrong for them, with staggering consequences that include uncontrolled hypertension, higher risk for stroke and heart attack, avoidable side effects, and billions of wasted health care dollars. Here, Dr. Mann, a nationally recognized hypertension specialist, identifies the drugs most likely to have side effects, and those that can be used in their place. He describes the shortcomings of some of the new drugs, while also introducing readers to some excellent old drugs that are woefully underused as a result of the publicity blitz surrounding the new, expensive ones. He emphasizes the importance of matching the medication and dosage to the individual who will be taking them, and presents the overlooked clues that can tell us who should be on which drug (even an excellent drug can be the wrong one if it is given to the wrong person or in the wrong dose). Hypertension and You is directed at the more than 50 million Americans (including a majority of people over the age of 60) who are taking blood pressure medication. Many patients suspect they might be on the wrong medication, but don’t know enough to be sure. This book shows how medications can be prescribed more wisely to achieve better results and gives patients the knowledge they need to capably discuss their medications with their health care providers. Hypertension and You provides many ideas and approaches that will be new to readers, and also to many physicians, and which no other book offers. It’s the first book to make the case that something is terribly wrong with how doctors are prescribing drugs for this condition. It provides readers with better knowledge of the available medications, empowering them to work with their physician to get onto the medications that are right for them.

Now in its thoroughly updated Fourth Edition, the Hypertension Primer is a comprehensive, readable source of state-of-the-art scientific and clinical information on hypertension. The book contains 171 short chapters by distinguished experts that cover every aspect of hypertension and its pathogenesis, epidemiology, impact, and management. Highlights of this edition include updated JNC 7 findings regarding special population therapy and clinical management. Chapters are grouped into three well-organized sections--basic science, population science, and clinical management--and each chapter is cross-referenced to other relevant chapters. Each chapter is easily digestible and begins with a bulleted list of key points.

Provides a resource for health care professionals who evaluate and manage patients with hypertension. Topics include hypertension in adolescents, treatment of hypertension in athletes, hypertension and weight loss, salt and dietary change to control blood pressure, and more.

Hypertension has become a major public health hazard not only in industrialized nations, but also in emerging economies. Early detection combined with effective treatment is imperative to reduce the risk of patients developing premature cardiovascular disease and accelerated atherosclerosis. A clear, concise resource, Hypertension: A Clinical Guide