Hypertension Medicine

449 Pages·2001·8.024 MB·English

by  Henry R. Black MD (auth.), Michael A. Weber MD (eds.)

HYPERTENSION MEDICINE
0 0
CURRENT CLINICAL PRACTICE
Hypertension Medicine, edited by MICHAEL A. WEBER, MD, 2001
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HYPERTENSION
MEDICINE
Edited by
A.
MICHAEL WEBER, MD
State University ofN ew York
Downstate College ofM edicine
Brooklyn, New York
Foreword by
K.
NORMAN HOLLENBERG, MD, PhD
Brigham and Womens Hospital, Boston, MA
*-
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
Dedication
To my wife, Sandra
© 2001 Springer Science+Business Media New York
Originally published by Humana Press Inc. in 2001
Softcover reprint of the hardcover 1s t edition 2001
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informatien published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug se1ections
and dosages set forth in this text are accurate and in accord with the standards accepted at the time ofpublication. Notwithstanding, as new research,
changes in governmentregulations, and knowledge from c1inical experiencerelatingto drug therapy and drugreactions constantly occurs, the readeT
is advised to check the product informatien provided by the manufacturer of each drug for any change in dosages Of for additional wamings and
contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of
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\098765432
Library of Congress Cataloging-in-Publication Data
Hypertension medicine / edited by Michael A. Weber.
p. ;cm. --(Current clinical practice)
Includes bibliographical references and index.
ISBN 978-1-4757-5446-9 ISBN 978-1-59259-008-7 (eBook) (alk. paper)
DOI 10.1007/978-1-59259-008-7
l. Hypertension. 1. Weber, Michael A. Il. Series.
[DNLM: 1. Hypertension--drug therapy. 2. Antihypertensive Agents--therapeutic use.
3. Hypertension--diagnosis. WG 340 H9958 2000)
RC685.H8 H85 2000
616.1 '32--Jc21 00-033587
FOREWORD
This is an outstanding book. We live in an age where a declaration of conflict
of interest is expected. Let me confess that Dr. Weber and I are long-standing
friends who have worked together on many occasions, in fact, we worked
together on a major projectthe week thatthe pages oft his book arrived. Clearly,
I would have had a problem if this book was less than excellent, but it is not.
Hypertension is a major medical problem, almost certainly the most com
mon chronic disease in the urban world. With the exception of pediatrics, at
least 20-25% of patients seen in any practitioner's office-whether they prac
tice general medicine or a subspecialty-have hypertension as part of their
medical story. Over the past 30 years, the management of hypertension has
moved from a formulaic approach that experts tried to apply to everyone, to
highly individualized management. This is a field that is evolving quickly, not
only in the area of pathogenic insight, but also in the areas of blood-pressure
control, which measures should receive priority, and identification of patient
subsets in whom special goals or approaches to therapy are appropriate. We
have a wide range of choices, and clearly want to use the available approaches
to their best advantage.
Each chapter in this book has been written by an authority in the field.
Equally important, or perhaps more important, is the remarkably focused chap
ter headings. In most books, what would have been a single subject is addressed
in three chapters, as one example. The first of this triad focuses on the concepts
involved in setting targets when starting hypertension treatment. The next
chapter focuses on choosing the first agent. The third chapter in the triad
focuses on managing an inadequate response to the first agent. Why does this
strategy work so well, which it does? The answer, I believe, lies in the focus.
Because the author has only that specific topic to address, it is addressed in
adequate detail. These are, after all, the truly important questions. Samuel
Goldwyn is reputed to have said "Never make predictions, especially about the
future." To close this Foreword, I am going to make a prediction. This is going
to be a very successful publication. There is something in it for everyone who
sees patients, and it is well-informed, thoughtfully organized, well written, and
judicious in the selection of emphasis and of detail.
Norman K. Hollenberg, MD, PhD
Brigham and Woman's Hospital, Boston, MA
v
PREFACE
Hypertension Medicine is intended to be read by clinicians and to be helpful
in a practical and immediate fashion. I have chosen topics that should cover
common questions and emerging areas of interest. It always seems logical to
explore in depth the basic sciences and epidemiology that provide the underpin
nings of our knowledge of hypertension practice. But I have tried to avoid this
temptation, using only the background necessary to explain or amplify clinical
ideas.
We have emphasized brevity. I have asked our authors to minimize references
and to prepare chapters short enough to be read comfortably at one sitting. We
have sought an informal tone, as though the writer and the reader are having a
collegial conversation. I have also asked the authors not to shy away from
controversy or personal opinions; candor is vital when sharing clinical informa
tion and new concepts with colleagues.
The first section of Hypertension Medicine deals with the relevant back
ground to hypertension: why we diagnose it, and why in most patients we now
believe it should be treated aggressively. We then consider some of the major
underlying mechanisms of hypertension, particularly those that help explain our
approaches to treatment. The next section focuses on techniques for evaluating
patients before treatment, bearing in mind that so many hypertensive patients
have concomitant conditions like lipid disorders and diabetes mellitus, and often
already have evidence of cardiovascular and renal changes. The final section
deals with treatment. The discussion of antihypertensive drugs is relatively
short. Rather, our major emphasis is in dealing with practical issues of manage
ment: how to select treatment to optimize results in difficult-to-treat hyperten
sive patients, and how to deal with major concomitant problems.
I am grateful to my many colleagues who were willing to share their expert
knowledge and contribute chapters to this book. I also thank my distinguished
friend Norman Hollenberg for agreeing to write a foreword, and my office co
ordinator Jeanne Minsky who worked so effectively with the authors and the
dedicated editorial staff at Humana Press in bringing this project together.
Michael A. Weber, MD
vii
CONTENTS
Foreword ........................................................................................................... v
Preface ............................................................................................................ vii
Contributors ................................................................................................... xiii
P ART I. BACKGROUND ISSUES IN HYPERTENSION .......................... 1
1 Studies Justifying the Use of Treatment to Prevent
Cardiovascular Events ..................................................... 3
Henry R. Black
2 Effects of Aging on Blood Pressure .................................. 21
Vincent DeQuattro
3 Effects of Race on Blood Pressure .................................... 27
John M. Flack
4 Genetics in Hypertension ................................................... 33
Joel M. Neutel and David H. G. Smith
5 Sodium and Other Dietary Factors ................................... .4 7
Myron H. Weinberger
6 Role of Stress in Development of Hypertension ............... 55
Thomas G. Pickering
7 Neuroendocrine Factors: Role of the Sympathetic Nervous
and Renin Angiotensin Systems ..................................... 89
Stevo Julius
8 Left Ventricular Hypertrophy and Diastolic Dysfunction 99
George A. Mansoor and William B. White
9 Role of the Endothelium in Hypertension ....................... 111
Ellis R. Levin
PART II. DIAGNOSIS AND SPECIAL TESTS .................................. 119
10 Systolic, Diastolic, Mean, or Pulse Pressure: Which Is
the Best Predictor of Hypertensive
Cardiovascular Risk? .................................................. 121
Stanley S. Franklin
ix
x Contents
11 Manual Blood Pressure Measurement--Still the Gold
Standard: Why and How to Measure Blood Pressure
the Old Fashioned Way ................................................. 131
Carlene M. Grim and Clarence E. Grim
12 Initial Routine Tests for Diagnosis and Risk
Stratification of the Patient with Hypertension:
What Is Mandatory? .................................................... 147
Tudor Vagaonescu and Robert A. Phillips
13 When to Suspect Secondary Hypertension ..................... 157
Donald G. Vidt
14 Evaluation of Renal Function and
Proteinuria .................................................................... 167
Ira W. Reiser and Jerome G. Porush
15 Ambulatory Blood Pressure Monitoring ......................... 181
David H. G. Smith
16 Arterial Compliance in Hypertension .............................. 191
G. E. McVeigh and Li Lan Yoon
PART III. PRINCIPLES OF TREATMENT ...................................... 199
17 Starting Hypertension Treatment: Setting Targets ......... 201
Michael A. Weber
18 Choosing the First Agent ................................................. 209
Matthew R. Weir
19 Managing an Inadequate Response to the First Agent:
Changing Doses or Drugs, Adding Drugs .................. 223
L. Michael Prisant
20 Rationale of Low-Dose Combination Therapy in
Cardiovascular Risk Management ............................... 231
Joel M. Neutel and David H. G. Smith
21 How to Monitor Progress in Hypertensive Patients ........ 245
Ehud Grossman
22 Problems of Treatment Compliance
and Polypharmacy ....................................................... 255
Gordon S. Stokes and Philip A. Atkin
23 Should Treatment Differ in African-American
and Caucasian Patients? .............................................. 265
W. Dallas Hall
Contents xi
24 Measuring the Benefits of Antihypertensive Treatment. 275
Michael A. Weber
PART IV. MAJOR HYPERTENSIVE DRUG CLASSES ..................... 283
25 Diuretics in Hypertension Therapy ................................. 285
James R. Sowers, Joel M. Neutel, and Matthew R. Weir
26 ~-Adrenergic Blocker Treatment of Hypertension:
Pharmacodynamics and Guide to Patient Selection .. 289
Jon D. Blumenfeld
27 Calcium Antagonists ........................................................ 301
Franz H. Messerli, Jayant Dey, and Zhanbin Feng
28 Angiotensin-Converting Enzyme Inhibitors ................... 315
Irene Gavras and Haralambos Gavras
29 The Angiotensin II Receptor Blockers ............................ 325
Michael A. Weber
30 ;:~:;t~v~.iz~:,l~~.kers ..................................................... 333
31 Centrally Acting Antihypertensive Drugs ....................... 339
Mark Houston
P ART V. SOLVING PROBLEMS IN HYPERTENSION MANAGEMENT. 349
32 The National Health and Nutrition Examination Survey III:
How Are We Doing with Blood Pressure Control? ... 351
David A. Calhoun and Suzanne Oparil
33 Lipid Abnormalities and Hypertension ........................... 367
Thomas D. Giles
34 Diabetes and Hypertension .............................................. 375
Kurt M. R. Sowers and James R. Sowers
35 Treatment of Hypertensive Patients with Chronic
Renal Insufficiency ...................................................... 383
Samuel Spitalewitz and Jerome G. Porush
36 Treating Angina Pectoris in Hypertension ...................... 395
Hal L. Chadow and Joel A. Strom
37 Hypertension and Its Treatment in Concomitant Conditions:
Degenerative Joint Disease, Depression, Alzheimer's
Disease, and Parkinson's Disease ............................... 403
Domenic A. Sica
XlI Contents
38 Cognitive Disorders and Dementia in Hypertension:
Implications for Treatment .......................................... 411
Lena Kilander
39 Refractory Hypertension .................................................. 419
C. Venkala S. Ram
40 Hypertensive Emergencies ............................................. .429
Dilek K. Sowers
41 Referring to Hypertension Experts:
The Hypertension Consultant ...................................... 437
Lawrence R. Krakoff
Index .............................................................................................................. 447