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.

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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.

Capturing the real spirit of creativity in physiology, this book explores the personal elements involved in scientific discovery. Circulation of the Blood is the story of the people and achievements that have changed the way we've come to view the human body. The authors, renowned for their extensive experience in the field, examine the heritage of creative genius involved in physiology and trace the historical development of ideas relating to various aspects of circulation of the blood. Their comprehensive coverage goes from the early discoveries of the Greeks and Romans up to modern times.

This book provides teaching scripts for medical educators in internal medicine and coaches them in creating their own teaching scripts. Every year, thousands of attending internists are asked to train the next generation of physicians to master a growing body of knowledge. Formal teaching time has become increasingly limited due to rising clinical workload, medical documentation requirements, duty hour restrictions, and other time pressures. In addition, today’s physicians-in-training expect teaching sessions that deliver focused, evidence-based content that is integrated into clinical workflow. In keeping with both time pressures and trainee expectations, academic internists must be prepared to effectively and efficiently teach important diagnostic and management concepts. A teaching script is a methodical and structured plan that aids in effective teaching. The teaching scripts in this book anticipate learners’ misconceptions, highlight a limited number of teaching points, provide evidence to support the teaching points, use strategies to engage the learners, and provide a cognitive scaffold for teaching the topic that the teacher can refine over time. All divisions of internal medicine (e.g. cardiology, rheumatology, and gastroenterology) are covered and a section on undifferentiated symptom-based presentations (e.g. fatigue, fever, and unintentional weight loss) is included. This book provides well-constructed teaching scripts for commonly encountered clinical scenarios, is authored by experienced academic internists and allows the reader to either implement them directly or modify them for their own use. Each teaching script is designed to be taught in 10-15 minutes, but can be easily adjusted by the reader for longer or shorter talks. Teaching Scripts in Internal Medicine is an ideal tool for internal medicine attending physicians and trainees, as well as physician’s assistants, nurse practitioners, and all others who teach and learn internal medicine.

Arterial hypertension, coronary heart disease and heart fail ure are the commonest cardiovascular conditions to present in clinical practice. Over the past few years it has become in creasingly clear that they are closely and causally interrelated and that their relationship can have a significant bearing on prognosis. Epidemiological studies have shown that arterial hypertension is one of the most important risk factors for de veloping heart failure. Only one in four patients with hyper tension is adequately managed, and in 50% of cases, the hypertension has not been recognised or treated. Patients with pre-existing hypertension who go on to suffer an acute myocardial infarction have usually not previously had typi cal angina symptoms, the infarct territory is larger, life threatening arrhythmias are commoner and hence in-hospi tal mortality and long-term prognosis are markedly worse. The presence of raised blood pressure in the post-infarct phase doubles the risk of manifest heart failure. The close relationship between hypertension, coronary heart disease and heart failure makes the choice of therapeu tic strategy particularly important. Agents and classes of agents that have prognostic value in all three conditions should be considered first, as synergy might result in addi tional benefits. In such patients, this sort of therapeutic deci sion-making might have further advantages. The use of these agents may prevent complications which are not yet clinically obvious (such as heart failure).