Skip to main content
SpringerLink
Log in

Arterial Hypertension

  • Chapter
  • First Online:
Comprehensive Cardiovascular Medicine in the Primary Care Setting

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

High blood pressure (BP) is a very important cardiovascular (CV) risk factor and is often labeled the “silent killer” because arterial hypertension will lead to serious CV events such as ischemic heart disease, stroke, and heart failure. Moreover, uncontrolled essential hypertension also leads to renal insufficiency, which accelerates the process of blood pressure elevation (1, 2). There is a shift regarding diagnosis and treatment of arterial hypertension. With aging, systolic hypertension is becoming a more important risk factor than diastolic hypertension and is more difficult to control.

Key Points

• High blood pressure is one of the most important cardiovascular risk factors.

• The general cutpoint for hypertension is 140/90 mmHg.

• In diabetes mellitus and chronic kidney disease, the BP goal should be lower than 130/80 mmHg.

• Prehypertension is a cardiovascular risk factor.

• The pathogenesis of essential hypertension is a heterogeneous process and several systems are involved in the changes of cardiovascular hemodynamics.

• In more than 90% of patients, elevated blood pressure is due to essential hypertension, in which genetic and environmental factors are involved.

• Interpretation of blood pressure values is dependent on whether they are measured in the office, at home, or during a 24-h ambulatory BP recording.

• In the evaluation of hypertension, other risk factors have to be taken into consideration.

• Treatment of hypertension is not only lowering blood pressure but the main aim is to reduce the risk for CV morbidity and mortality as well to preserve renal function.

• Antihypertensive treatment should be focused on lifestyle changes and personalized blood pressure lowering therapy in the context of other concomitant morbid conditions.

• Several landmark trials have shown that there can be a difference in cardiovascular and renal outcome, depending on how blood pressure is lowered.

• Age is not a contraindication to lowering blood pressure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cohn JN. Arteries, myocardium, blood pressure and cardiovascular risk towards a revised definition of hypertension. J Hypertens. 1998;16:2117–2124.

    PubMed  CAS  Google Scholar 

  2. Lloyd-Jones DM, Leip EP, Larson MG, Vasan RS, Levy D. Novel approach to examining first cardiovascular events after hypertension onset. Hypertension. 2005;45:39–45.

    PubMed  CAS  Google Scholar 

  3. Giles TD, Berk BC, Black HR, et al. Expanding the definition and classification of hypertension. J Clin Hypertens. 2005;7:505–512.

    Article  Google Scholar 

  4. Lewington S, Clarke R, Quizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–1913.

    Article  PubMed  Google Scholar 

  5. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 2003;290:199–206.

    Article  PubMed  Google Scholar 

  6. Freis ED. Studies in hemodynamics and hypertension. Hypertension. 2001;38:1–5.

    Article  PubMed  CAS  Google Scholar 

  7. Duprez DA, Kaiser DR, Whitwam W, et al. Determinants of radial artery pulse wave analysis in asymptomatic individuals. Am J Hypertens. 2004;17:647–653.

    Article  PubMed  Google Scholar 

  8. Guyton AC. Dominant role of the kidneys and accessory role of whole-body autoregulation in the pathogenesis of hypertension. Am J Hypertens. 1989;2:575–585.

    PubMed  CAS  Google Scholar 

  9. Duprez DA. Role of the renin–angiotensin–aldosterone system in vascular remodeling and inflammation: a clinical review. J Hypertension. 2006;24:983–991.

    Article  CAS  Google Scholar 

  10. Pepe S, Lakatta EG. Aging hearts and vessels: masters of adaptation and survival. Cardiovasc Res. 2005;66:190–193.

    Article  PubMed  CAS  Google Scholar 

  11. Textor SC, Wilcox CS. Renal artery stenosis: a common, treatable cause of renal failure. Annu Rev Med. 2001;52:421–442.

    Article  PubMed  CAS  Google Scholar 

  12. Williams JS, Williams GH, Raji A, et al. Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia. J Hum Hypertens. 2006;20:129–136.

    Article  PubMed  CAS  Google Scholar 

  13. Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma, which test is best. JAMA. 2002;287:1427–1434.

    Article  PubMed  CAS  Google Scholar 

  14. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117:e510–e526.

    Article  PubMed  Google Scholar 

  15. Calhoun D. Use of aldosterone antagonists in resistant hypertension. Prog Cardiovasc Dis. 2006;48:387–396.

    Article  PubMed  CAS  Google Scholar 

  16. Elliott-William J. Clinical features in the management of selected hypertensive emergencies. Prog Cardiovasc Dis. 2006;48:316–325.

    Article  CAS  Google Scholar 

  17. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA. 2003;289:2560–2572.

    Article  Google Scholar 

  18. World Health Organization–International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines subcommittee. J Hypertens. 1999;17:151–183.

    Google Scholar 

  19. American Heart Association. Recommendations for human blood pressure determination by sphygmomanometers. Report of a special task force appointed by the steering committee. Hypertension. 1988;11:210A–222A.

    Google Scholar 

  20. O’Brien E, Asmar R, Beilin L, et al. On behalf of the European Society of Hypertension Working Group on blood pressure monitoring. Practice guidelines of the European Society of hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertension. 2005;23:697–701.

    Article  Google Scholar 

  21. Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354:2368–2374.

    Article  PubMed  CAS  Google Scholar 

  22. Clement DL, De Buyzere M, De Bacquer DA, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348:2407–2415.

    Article  PubMed  Google Scholar 

  23. White WB. Ambulatory blood-pressure monitoring in clinical practice. N Engl J Med. 2003;348:2377–2378.

    Article  PubMed  Google Scholar 

  24. Chobanian AV, Bakris GL, Black HR, et al. National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report. JAMA. 2003;289:3560–3572.

    Article  Google Scholar 

  25. Mancia G, De Backer G, Dominiczak A, et al. ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC task force on the management of arterial hypertension. J Hypertens. 2007;25:1751–1762.

    Article  PubMed  CAS  Google Scholar 

  26. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486–2497.

    Google Scholar 

  27. He J, Whelton PK, Appel LJ, Charleston J, Klag MJ. Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension. 2000;35:544–549.

    Article  PubMed  CAS  Google Scholar 

  28. Sacks FM, Svetkey LP, Vollmer WM, et al. For the DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med. 2001;344:3–10.

    Article  PubMed  CAS  Google Scholar 

  29. Officers ALLHAT. Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA. 2002;288:2981–2997.

    Article  Google Scholar 

  30. Moser M. Physician or clinical inertia: what is it? Is it really a problem? And what can be done about it. J Clin Hypertens. 2009;11:1–4.

    Article  Google Scholar 

  31. Duprez DA. Aliskiren: the next innovation in renin-angiotensin-aldosterone system blockade. Aging Health. 2009;5:269–279.

    Article  CAS  Google Scholar 

  32. Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs. Lancet. 2000;356:1955–1964.

    Article  Google Scholar 

  33. Brown MJ, Palmer CR, Castaigne A, et al. Morbidity and mortality in patients randomized to doubleblind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: intervention as a goal in hypertension treatment (INSIGHT). Lancet. 2000;356:366–372.

    Article  PubMed  CAS  Google Scholar 

  34. Zanchetti A, Bond G, Hennig M, et al. Calcium antagonist slows down progression of asymptomatic carotid atherosclerosis. Principal results of the European Lacidipine study on atherosclerosis (ELSA), a randomised, double-blind, long-term trial. Circulation. 2002;106:2422–2427.

    Article  PubMed  CAS  Google Scholar 

  35. Nissen SE, Tuczu EM, Libby P, et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary artery disease and normal blood pressure. The CAMELOT Study: a randomized controlled trial. JAMA. 2004;292:2217–2226.

    Article  PubMed  CAS  Google Scholar 

  36. Black HR, Elliott WJ, Grandits G, et al. Principal results of the Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints (CONVINCE) trial. JAMA. 2003;289:2073–2082.

    Article  PubMed  CAS  Google Scholar 

  37. Julius S, Kjelden SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet. 2004;363:2022–2031.

    Article  PubMed  CAS  Google Scholar 

  38. Weber MA, Julius S, Kjeldsen SE, et al. Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE trial. Lancet. 2004;363:2049–2051.

    Article  PubMed  CAS  Google Scholar 

  39. Dahlöf B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian cardiac outcomes trial-blood pressure lowering arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366:895–906.

    Article  PubMed  Google Scholar 

  40. Williams B, Lacy PS, Thom SM, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes. Circulation. 2006;113:1213–1215.

    Article  PubMed  CAS  Google Scholar 

  41. Julius S, Nesbitt SD, Egan BM, et al. Feasibility of treating prehypertension with an angiotensin receptor blocker. N Engl J Med. 2006;354:1685–1697.

    Article  PubMed  CAS  Google Scholar 

  42. Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359:2417–2428.

    Article  PubMed  CAS  Google Scholar 

  43. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–1898.

    Article  PubMed  CAS  Google Scholar 

  44. ONTARGET Investigators, Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–1559.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiovascular Division, University of Minnesota, Minneapolis, MN, 55455, USA

    Daniel A. Duprez MD, PhD

Authors
  1. Daniel A. Duprez MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Sterling Rock Falls Clinic, 101 E. Miller Road, Sterling, 61081, USA

    Peter P. Toth

  2. Brigham & Women's Hospital, Cardiovascular Division, Harvard Medical School, Longwood Ave. 350, Boston, 02115, USA

    Christopher P. Cannon

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Duprez, D.A. (2011). Arterial Hypertension. In: Toth, P., Cannon, C. (eds) Comprehensive Cardiovascular Medicine in the Primary Care Setting. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-963-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-963-5_2

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-962-8

  • Online ISBN: 978-1-60327-963-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation