Hypertensive disease: current challenges, new concepts, and management
From the Publisher: This issue of the Medical Clinics of North America brings the practicing clinician up to date on the current challenges, new concepts, and management of hypertensive disease. Topics covered include risks in hypertension; new biological concepts of target organ involvement in hype...
Gespeichert in:
| Weitere Verfasser: | |
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| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pa.
Saunders
2009
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| Schriftenreihe: | Medical clinics of North America
93,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Zusammenfassung: | From the Publisher: This issue of the Medical Clinics of North America brings the practicing clinician up to date on the current challenges, new concepts, and management of hypertensive disease. Topics covered include risks in hypertension; new biological concepts of target organ involvement in hypertension; hypertension and the metabolic syndrome; aging versus hypertension; hypertension, systolic blood pressure, and large arteries; oxidative stress, endothelial dysfunction, and hypertension; current thinking about hypertensive heart disease; diastolic dysfunction as a link between hypertension and heart failure; hypertension and cardiac failure in its various forms; hypertension and atherogenesis; the kidney, hypertension, and remaining challenges; current thinking about renovascular hypertension; obesity and hypertension; and barriers to adherence in hypertension management. |
| Beschreibung: | XX S., S. 527 - 786 Ill., graph. Darst. |
| ISBN: | 9781437710045 1437710042 |
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| 245 | 1 | 0 | |a Hypertensive disease |b current challenges, new concepts, and management |c guest ed. Edward D. Frohlich |
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| 490 | 1 | |a Medical clinics of North America |v 93,3 | |
| 520 | 3 | |a From the Publisher: This issue of the Medical Clinics of North America brings the practicing clinician up to date on the current challenges, new concepts, and management of hypertensive disease. Topics covered include risks in hypertension; new biological concepts of target organ involvement in hypertension; hypertension and the metabolic syndrome; aging versus hypertension; hypertension, systolic blood pressure, and large arteries; oxidative stress, endothelial dysfunction, and hypertension; current thinking about hypertensive heart disease; diastolic dysfunction as a link between hypertension and heart failure; hypertension and cardiac failure in its various forms; hypertension and atherogenesis; the kidney, hypertension, and remaining challenges; current thinking about renovascular hypertension; obesity and hypertension; and barriers to adherence in hypertension management. | |
| 650 | 4 | |a Cardiovascular Diseases |x etiology | |
| 650 | 4 | |a Hypertension | |
| 650 | 4 | |a Hypertension |x complications | |
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Datensatz im Suchindex
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| adam_text | Titel: Hypertensive disease
Autor: Frohlich, Edward D.
Jahr: 2009
Contents
Preface xv
Edward D. Frohlich
Current Challenges and Unresolved Problems in Hypertensive Disease 527
Edward D. Frohlich
Over the past four or five decades, hypertension and cardiovascular
medicine has experienced dramatic and innovative changes that have
significantly reduced morbidity and mortality. A vast array of new antihy-
pertensive compounds have been developed, which are able to inhibit
many pathophysiologic mechanisms of the disease and prevent many of
the outcomes in patients with hypertension. Much of this series of thera¬
peutic breakthroughs have been the result of active participation of clinical
scientists with tremendous and remarkable knowledge of and experience
with the fundamental mechanisms of disease. In more recent years, much
new information has appeared concerning the basis genetic and biologic
mechanisms involved in cardiovascular and renal diseases. What remains
of utmost importance is for members of the academic community with
a wide spectrum of experience and points of view to continue to work
with the fundamental problems and mechanisms of the diseases.
Hypertension: Reflections on Risks and Prognostication 541
William B. Kannel
Framingham Heart Study cardiovascular disease prospective population
epidemiologic research has played an important role in the evolution of
modern cohort study design and the advancement of preventive cardiol¬
ogy. To date no single essential factor has been identified; multiple inter¬
related factors are promoting increased risk for development of CHD.
Elevated blood pressure has emerged as a prominent member of cardio¬
vascular risk factors. The study s documentation of a strong link of blood
pressure to development of cardiovascular events stimulated the pharma¬
ceutical industry to develop medications for controlling blood pressure
and, in turn, national campaigns to combat hypertension and its adverse
vascular outlook.
New Insights into Target Organ Involvement in Hypertension 559
Richard N. Re
Optimization of the care of the hypertensive patient will require not only
attention to the regulation of arterial pressure but also to blunting the
hypertension-related processes that lead to vascular disease. It is clear
that the regulation of these processes is much more complex than
previously understood. Here several new insights into the pathogenesis
of hypertension-related vascular disease are explored with an emphasis
on the role played by the renin-angiotensin systems.
The Renin Angiotensin Aldosterone System in Hypertension: Roles of Insulin
Resistance and Oxidative Stress 569
Camila Manrique, Guido Lastra, Michael Gardner, and James R. Sowers
Hypertension (HTN) is a leading risk factor for cardiovascular disease
(CVD) and chronic kidney disease (CKD)-related morbidity and mortality.
Several abnormalities participate in the development of HTN. Inappropri¬
ately activated systemic and local tissue renin angiotensin aldosterone
systems (RAAS) contribute to the hemodynamic and metabolic abnormal¬
ities that lead to endothelial dysfunction, HTN, CVD, and CKD. There is
a growing body of evidence demonstrating a close relationship between
RAAS activation, excessive production of reactive oxygen species, insulin
resistance, and HTN. From a therapeutic standpoint, RAAS blockade
results in improved insulin resistance, glucose homeostasis, and improved
cardiovascular and renal outcomes. This article is focused on the role of
RAAS-mediated insulin resistance and oxidative stress in the pathogene-
sis of HTN, CVD, and CKD.
Arterial Aging and Subclinical Arterial Disease are Fundamentally Intertwined
at Macroscopic and Molecular Levels 583
Edward G. Lakatta, Mingyi Wang, and Samer S. Najjar
The structure and function of arteries change throughout a lifetime. Age is
the dominant risk factor for hypertension, coronary heart disease, conges¬
tive heart failure, and stroke. The cellular/molecular proinflammatory
alterations that underlie arterial aging are novel putative candidates to
be targeted by interventions aimed at attenuating arterial aging as a major
risk factor for cardiovascular diseases. This review provides a landscape
of central arterial aging and age-disease interactions, integrating perspec¬
tives that range from humans to molecules, with the goal that future
therapies for cardiovascular diseases, such as hypertension, also will
target the prevention or amelioration of unsuccessful arterial aging.
Hypertension, Systolic Blood Pressure, and Large Arteries 605
Michel E. Safar
This article discusses the following: (1) factors modulating central and pe¬
ripheral SBP and PP in hypertensive subjects; (2) mechanisms enhancing
PP variations in this population; (3) Analysis of pulsatile arterial hemody-
namics as predictors of CV risk; and (4) Pulsatile hemodynamics and strat¬
egies lowering CV risk in the treatment of hypertension.
Oxidative Stress and Hypertension 621
David G. Harrison and Maria Carolina Gongora
Reactive oxygen species (ROS) oxidize, reduce, or combine with other
molecules in both physiologic and pathophysiologic ways. This article ex¬
amines the role of ROS in hypertension, especially in certain tissues, such
as the brain, the kidney, and the vasculature. A major clinical challenge is
that the routinely used antioxidants are ineffective in preventing or treating
cardiovascular disease and hypertension. This is likely because these
drugs are either ineffective or act in a nontargeted fashion, such that
they remove not only injurious ROS but also those involved in normal
cell signaling. Inflammatory cells such as T cells may contribute to hyper¬
tension, and further investigation of how this occurs may lead to new
therapies.
Towards a New Paradigm About Hypertensive Heart Disease 637
Javier Diez
A new paradigm is emerging related to the impact of chronic hypertension
on the cardiac parenchyma. Whereas left ventricular hypertrophy may be
detected early and accurately in hypertensive patients by electrocardiog-
raphy and echocardiography, newer cardiac imaging methods and the
monitoring of several circulating biomarkers holds promise as a noninva-
sive tool for the diagnosis of myocardial remodeling. A large number of
clinical studies have shown that long-term antihypertensive treatment
may be associated with regression of left ventricular hypertrophy, and
this is associated with the decrease of the risk of cardiovascular morbidity
and mortality. However, because the remaining risk is unacceptably high,
new therapeutic strategies aimed not just to decrease left ventricular
mass, but also to repair myocardial remodeling are necessary. All of these
aspects are reviewed in brief in this article.
Diastolic Dysfunction as a Link Between Hypertension and Heart Failure 647
Anil Verma and Scott D. Solomon
Hypertension significantly contributes to cardiovascular morbidity and
mortality by causing substantial structural and functional adaptations,
including left ventricular diastolic dysfunction. Left ventricular diastolic
dysfunction is characterized by abnormalities in left ventricular filling,
including decreased diastolic distensibility and impaired relaxation, and
it may represent an early measure of myocardial end-organ damage. Dia¬
stolic dysfunction may well precede development of left ventricular hyper¬
trophy in hypertension and possibly is characteristic of an important
pathophysiologic link between hypertension and heart failure with pre¬
served ejection fraction. No specific therapeutic regimen has shown to
benefit patients who have heart failure with preserved ejection fraction,
and thus there is a need to understand the potential mechanisms primarily
responsible for this clinical syndrome and its relationship to hypertension
and diastolic dysfunction.
Hypertension and Cardiac Failure in its Various Forms 665
Krishna K. Gaddam, Anil Verma, Mark Thompson, Rohit Amin,
and Hector Ventura
Aging population and poorly controlled hypertension contribute to an ever-
increasing prevalence of heart failure. Two different phenotypes of heart
failure, namely, heart failure with reduced ejection fraction and heart failure
with preserved ejection fraction, are being increasingly recognized. How¬
ever, they may not necessarily be separate processes and may actually
represent a continuum. Nevertheless, either form of heart failure is associ¬
ated with very high morbidity and mortality. Significant advances have
been achieved in understanding the pathophysiology and treatment of pa¬
tients who have heart failure with reduced ejection fraction. However, heart
failure with preserved ejection fraction is less well understood and no con¬
vincing evidence-based treatment options are available in treating these
patients. Given the poor prognosis with either form of heart failure, it is
imperative to recognize and treat hypertension early.
Hypertension and Myocardial Ischemia 681
Brian P. Murphy, Tony Stanton, and Francis G. Dunn
There is an impressive evidence base for the presence of myocardial is¬
chemia in patients who have hypertension. This relationship ranges from
the obvious association with obstructive coronary artery disease to more
subtle mechanisms related to hemodynamic, microcirculatory, and neuro-
endocrine abnormalities. All of these factors serve to destabilize the critical
balance between myocardial oxygen supply and demand. We have at our
disposal a range of sophisticated investigations that allow us to demon¬
strate the presence and extent of the ischemia and therefore to target spe¬
cific therapies to reduce the risk to these patients. Achieving target blood
pressure and managing all reversible components of the patient s cardio¬
vascular risk status help to minimize the clinical sequelae of myocardial
ischemia in this vulnerable population.
The Kidney, Hypertension, and Remaining Challenges 697
Nitin Khosla, Rigas Kalaitzidis, and George L. Bakris
There is an epidemic of chronic kidney disease in the Western world, with
hypertension being the second most common cause. Blood pressure con¬
trol rates, while improving, are still below 50% for the United States
population. The following three challenges remain for the treatment of hy¬
pertension and associated prevention of end-stage kidney disease. First,
a better understanding by the general medical community of how and in
whom to use renin angiotensin aldosterone system blockers is needed.
Second, the appropriate initiation of fixed-dose combination therapy to
achieve blood-pressure goals needs to be clarified. Finally, the subgroup
of patients with kidney disease needs more aggressive blood pressure
lowering.
Current Approaches to Renovascular Hypertension 717
Stephen C. Textor
This article examines the status regarding prevalence, mechanisms, clini¬
cal manifestations and management of renovascular hypertension at this
point in time. It should be viewed as a work in progress. As with most com¬
plex conditions, clinicians must integrate the results of published literature
studies while considering each patient s specific features and comorbid
disease risks. Beyond identifying renovascular disease as a cause of
secondary hypertension, one must manage renal artery stenosis (RAS)
itself as an atherosclerotic vascular complication. This disease warrants
follow-up regarding progression and potential for ischemic tissue injury.
These elements often determine the role and timing for revascularization.
In this respect, atherosclerotic renal artery stenosis is analogous to pro¬
gressive carotid or aortic aneurysmal disease.
Obesity and Hypertension: Mechanisms, Cardio-Renal Consequences,
and Therapeutic Approaches 733
Efrain Reisin and Avanelle V. Jack
Obesity and its relationship to hypertension is growing worldwide and is
considered today to be a pandemic. This article focuses on the impact of
obesity and hypertension on the cardiovascular and renal systems. It also
summarizes the nonpharmacological and pharmacological approaches
used to control hypertension in the obese population.
Barriers to and Determinants of Medication Adherence in Hypertension
Management: Perspective of the Cohort Study of Medication Adherence
Among Older Adults 753
Marie A. Krousel-Wood, Paul Muntner, Tareq Islam, Donald E. Morisky,
and Larry S. Webber
Low adherence to antihypertensive medication remains a public health
challenge. Understanding barriers to, and determinants of, adherence to
antihypertensive medication may help identify interventions to increase
adherence and improve outcomes. The Cohort Study of Medication Ad¬
herence in Older Adults is designed to assess risk factors for low antihy¬
pertensive medication adherence, explore differences across age,
gender, and race subgroups, and determine the relationship of adherence
with blood pressure control and cardiovascular outcomes over time. This
article discusses the relevance of this study in addressing the issue of
barriers to anithypertensive medication adherence.
Index 771
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| spelling | Hypertensive disease current challenges, new concepts, and management guest ed. Edward D. Frohlich Philadelphia, Pa. Saunders 2009 XX S., S. 527 - 786 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Medical clinics of North America 93,3 From the Publisher: This issue of the Medical Clinics of North America brings the practicing clinician up to date on the current challenges, new concepts, and management of hypertensive disease. Topics covered include risks in hypertension; new biological concepts of target organ involvement in hypertension; hypertension and the metabolic syndrome; aging versus hypertension; hypertension, systolic blood pressure, and large arteries; oxidative stress, endothelial dysfunction, and hypertension; current thinking about hypertensive heart disease; diastolic dysfunction as a link between hypertension and heart failure; hypertension and cardiac failure in its various forms; hypertension and atherogenesis; the kidney, hypertension, and remaining challenges; current thinking about renovascular hypertension; obesity and hypertension; and barriers to adherence in hypertension management. Cardiovascular Diseases etiology Hypertension Hypertension complications Hypertension physiopathology Frohlich, Edward D. 1931- (DE-588)108494969 edt Medical clinics of North America 93,3 (DE-604)BV000003310 93,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017643137&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Hypertensive disease current challenges, new concepts, and management Medical clinics of North America Cardiovascular Diseases etiology Hypertension Hypertension complications Hypertension physiopathology |
| title | Hypertensive disease current challenges, new concepts, and management |
| title_auth | Hypertensive disease current challenges, new concepts, and management |
| title_exact_search | Hypertensive disease current challenges, new concepts, and management |
| title_full | Hypertensive disease current challenges, new concepts, and management guest ed. Edward D. Frohlich |
| title_fullStr | Hypertensive disease current challenges, new concepts, and management guest ed. Edward D. Frohlich |
| title_full_unstemmed | Hypertensive disease current challenges, new concepts, and management guest ed. Edward D. Frohlich |
| title_short | Hypertensive disease |
| title_sort | hypertensive disease current challenges new concepts and management |
| title_sub | current challenges, new concepts, and management |
| topic | Cardiovascular Diseases etiology Hypertension Hypertension complications Hypertension physiopathology |
| topic_facet | Cardiovascular Diseases etiology Hypertension Hypertension complications Hypertension physiopathology |
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