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The Natural History of Untreated Hypertension

Our knowledge about the natural history of untreated hypertension is mainly based on historical information from a relatively short duration of time (1900s to 1970s). During that period, there was a significant evolution in the understanding of the health-related impact of elevated blood pressure (BP) and in developing new antihypertensive medications ( Fig. 18.1 ) that solidified the awareness of the adverse association between untreated hypertension…

Hypertension in Children: Diagnosis and Treatment

Over the past decade, there has been increasing interest in childhood hypertension and greater recognition that adult cardiovascular disease has its origins in childhood. Fueling this interest has been the childhood obesity epidemic, which has led to an increase in the prevalence of hypertension and its consequences in the young. This chapter will discuss some of the recent trends in pediatric hypertension, with a focus on…

Secondary Hypertension: Sleep Disturbances Including Sleep Apnea

Obstructive Sleep Apnea and Hypertension Obstructive sleep apnea (OSA) and hypertension are common medical conditions which often coexist. Is there is a causal relationship between these two conditions? This question has been repeatedly raised in literature and has remained an area of interest for many years. The association between OSA and hypertension was initially reported by Tilkian et al in 1976 who demonstrated a substantial cyclical elevation…

Secondary Hypertension: Pheochromocytoma and Paraganglioma

Endocrine disorders account for about 5% to 10% of secondary hypertension. Pheochromocytoma and paraganglioma tumors are a well-established, albeit rare, cause of secondary hypertension. Pheochromocytomas and paragangliomas are tumors of the autonomic nervous system that arise from chromaffin tissue in the adrenal medulla and extraadrenal ganglia, respectively. Pheochromocytomas and most paragangliomas are derived from sympathetic nervous system tissue which secretes catecholamines and metanephrines. Some paragangliomas, however,…

Secondary Hypertension: Primary Hyperaldosteronism and Mineralocorticoid Excess States

Hypertension resulting from mineralocorticoid excess can be categorized based on levels of renin and aldosterone ( Box 14.1 ). Aldosterone, deoxycorticosterone, and cortisol are the three major mineralocorticoid receptor ligands. This chapter reviews the clinical presentation, diagnostic evaluation, and treatment of these three types of renin-independent mineralocorticoid excess states. BOX 14.1 Mineralocorticoid Excess States Low Renin and High Aldosterone Primary Aldosteronism Aldosterone-producing adenoma (APA)—35% of cases…

Renovascular Hypertension and Ischemic Nephropathy

Advances and Major Points of Emphasis 1. Definition of the spectrum of progressive clinical manifestations attributable to renovascular disease 2. Recognition that moderate reductions in renal blood flow do not induce tissue hypoxia or damage, thereby allowing ongoing medical therapy of renovascular hypertension. 3. Integration of limited prospective trial results into clinical practice in favor of optimized medical therapy using agents that block the renin-angiotensin system.…

White-Coat and Masked Hypertension

Traditionally, identification and management of hypertension has been based on office blood pressure (BP) measurements. However, after the introduction of methods to assess BP values under everyday life conditions, through either 24-hour ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM), there has been growing awareness about the substantial discrepancies between information on BP provided by these “out-of-office BP” methodologies and conventional office BP (OBP) measurements.…

Ambulatory Blood Pressure Monitoring in Clinical Hypertension Management

Before the early 1970s, intraarterial recordings provided the only means of following changes in blood pressure (BP) during the typical activities of daily living over a period of time. The development and commercial availability of lightweight, quiet, easy-to-wear automated noninvasive BP recorders has facilitated the collection of large volumes of data (∼100 measurements in 24 hours) while a subject pursues his or her everyday activities. Data…

Home Monitoring of Blood Pressure

Despite the fact that conventional measurement of blood pressure (BP) in the office (OBP) has been the cornerstone for hypertension diagnosis and management for decades, it is recognized that this method might often be misleading, mainly because of the white-coat and masked hypertension phenomena, which are common among both untreated and treated subjects. Furthermore, the small number of BP readings, the usually unstandardized setting and conditions,…

Office Blood Pressure Measurement

Because patients whose blood pressure (BP) rises to unhealthy levels usually have no symptoms to suggest the presence of this condition the only way to detect the “silent killer” is to measure the BP accurately. Thus, the major reason for measuring BP in the office is to detect the evolution of an unhealthy BP so treatment to lower the BP to healthy levels can be incorporated…

The Environment and High Blood Pressure

Hypertension is a polygenetic disorder provoked by remediable (e.g., sodium intake) as well as unmodifiable factors (e.g., aging). It accounts for up to half of cardiovascular events and is the leading risk factor for morbidity and mortality worldwide. To combat this public health epidemic, a number of lifestyle interventions (e.g., reduced sodium intake) have been extensively studied and proven over the years to effectively lower blood…

Inflammation and Immunity in Hypertension

Approximately one-third of the Western population has hypertension, and this disease becomes more frequent with aging. This disease is also a major risk factor for cardiovascular disease, causing stroke, heart failure, renal failure, and cognitive decline. Despite the frequency of hypertension and its profound impact on human health, the precise cause of most cases of human hypertension remains essentially unknown. Rare monogenic causes of hypertension have…

Genetics of Hypertension

Hypertension genetics is of interest to different health care professionals: The clinician is often embarrassed by patient questioning on the origins of the blood pressure (BP) elevation in the absence of risk factors and in the clinic, signs indicating the presence of a rare monogenic hypertensive syndrome are important to be recognized. The clinical-trialist can find proof for causality between BP and for example, target organ…

Pathogenesis of Hypertension

Acknowledgments The authors’ research was supported by grants from the National Heart, Lung and Blood Institute (PO1 HL51971), National Institute of General Medical Sciences (P20 GM104357), National Institute of Diabetes and Digestive and Kidney Diseases (1K08DK099415-01A1), and the American Heart Association. We thank Stephanie Lucas for expert assistance in preparing this chapter. Primary (essential) hypertension accounts for the vast majority (>90%) of human hypertension and involves…

Hypertension in South Asians

Elevated blood pressure (BP) is a growing health problem in South Asia, where it is the second largest risk factor for disability-adjusted life years lost, predominantly because of its strong relationship with cardiovascular disease (CVD) development. Within India, it has been estimated that hypertension accounts for 57% of all stroke related deaths and 24% of coronary artery disease related deaths. Thus, a significant proportion of death…

Hypertension in East Asians and Native Hawaiians

With the changes in lifestyle and increasing longevity, the prevalence of hypertension increases worldwide. However, several classes of efficacious antihypertensive drugs are readily available for the management of hypertension in most countries or regions. In the past several decades, several national or regional epidemiologic studies on hypertension and outcome trials on the management of hypertension were conducted in East Asians and native Hawaiians. In this chapter,…

Hypertension in Latin/Hispanic Population

Acknowledgments This work was supported by PI14/01841 grant from Instituto de Salud Carlos III and FONDOS FEDER. The term Hispanic or Latino refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race according to the definition of the United States Census Bureau published in 2010. The term includes a very relevant part of the…

General Population and Global Cardiovascular Risk Prediction

Systemic arterial hypertension is the condition of persistent, nonphysiologic elevation of systemic blood pressure (BP). It is typically defined as a resting systolic BP (SBP) 140 mm Hg or higher, or diastolic BP (DBP) 90 mm Hg or higher, or receiving therapy for the indication of BP-lowering. Hypertension afflicts a substantial proportion of the adult population worldwide, and a growing number of children. Numerous genetic, environmental,…

Decision Making and Palliative Care in Advanced Heart Failure

Existing therapies slow, but rarely reverse, heart failure disease progression. As a result, the prevalence of symptomatic heart failure has increased, as has the length of time that people spend in later stages of the disease. At the far end of the heart failure spectrum are a group of patients with advanced (Stage D) heart failure for whom symptoms limit daily life despite the usual recommended…

Quality and Outcomes in Heart Failure

Due to the prevalence and major morbidity of heart failure (HF), as well as its associated public health burden with regard to total health care expenditures, HF serves as one of the top conditions targeted for quality of care improvement. Randomized clinical trials have established the efficacy of several therapies to reduce all-cause mortality and to reduce the risk of other adverse outcomes for patients with…