1. What is the difference between mendelian (or monogenic) forms of hypertension and essential hypertension? Essential hypertension has a multifactorial etiology, including demographic and environmental (dietary) factors, and genetic predisposition, which results from multiple gene–gene and gene–environment interactions. Large genome-wide…
Volume 1. What is meant by volume? Physicians use the terms “volume” and “extracellular fluid volume” interchangeably. Because sodium is largely restricted to the extracellular fluid (ECF), total body sodium determines the ECF volume. Therefore changes in total body sodium…
1. What nonpharmacologic strategies can be used to treat hypertension? Several nonpharmacologic strategies are available to improve blood pressure control among essential hypertensive patients. By extension, similar strategies may be effective among patients with chronic kidney disease. These strategies include…
1. When is pharmacologic treatment of hypertension indicated? When an individual’s blood pressure (BP) does not fall below goal after a suitable period of intensive lifestyle modifications, antihypertensive drug therapy is universally recommended. There is general agreement that antihypertensive drug…
1. How does a “hypertensive emergency” differ from “hypertensive urgency”? A “hypertensive emergency” is a clinical situation in which severely elevated blood pressure is associated with acute, progressive target-organ damage that needs to be treated immediately with a safe and…
1. What is resistant hypertension (RH)? Is it the same as refractory hypertension? Hypertension is considered resistant if the blood pressure (BP) cannot be reduced below target levels ( Box 67.1 ) in patients who are compliant with an optimal…
1. Besides renovascular and the traditional endocrine causes of hypertension, what are eight uncommon, but important, causes of secondary hypertension? Obstructive sleep apnea (typically causing hyperaldosteronism) Drug-induced hypertension (especially nonsteroidal antiinflammatory drugs, steroids, and/or other immunosuppressants) Thyroid disorders (hypothyroidism more…
Hyperaldosteronism 1. What is hyperaldosteronism? Hyperaldosteronism is a disorder with a characteristic set of signs and symptoms resulting from excessive effects of aldosterone or a similar mineralocorticoid agent, which typically include: Hypertension: usually unresponsive to angiotensin converting-enzyme (ACE) inhibitors, angiotensin…
1. What clinical syndromes are associated with renal artery stenosis? Renovascular hypertension, progressive loss of kidney function from ischemic nephropathy, and recurrent episodes of flash pulmonary edema (meaning acute/abrupt onset pulmonary edema) are the clinical syndromes typically associated with renal…
1. What is the epidemiology of hypertension? Hypertension remains a common disease among Americans. Data from the National Health and Nutrition Examination Survey reveal that 29% of Americans are hypertensive; this prevalence rate has remained stable for the past 15…