Current Issues in Hypertension

Hypertension affects one quarter of all adults in the developed world. If not treated early and correctly, complications such as heart failure, renal disease, and cerebral hemorrhage can occur. Significant advances in treatment - new drugs, combination therapies, dietary practice - have created confusion at the primary care level and in hospital hypertension clinics. Clarifies areas of contradiction and confusion to provide clinician with unambiguous guidelines on best practice in hypertension management. Covers epidemiological studies, assessment, and treatment. The author - Neil Poulter, a professor of preventive cardiovascular medicine at Imperial College School of Medicine, St Mary's Hospital, London, UK - is recognized internationally as one of the foremost authorities in the field. For primary care doctors and specialist nurses.

Introduction

vii

1 Epidemiology

1

(24)

Definition of hypertension

2

(3)

Distribution of hypertension

5

(4)

Aetiology of raised BP

9

(4)

Natural history of hypertension

13

(12)

2 How should patients with hypertension be assessed?

25

(18)

BP measurement

26

(3)

Medical History

29

(1)

Examination

30

(1)

Investigations

30

(1)

Global risk assessment

31

(12)

3 At what level should drug treatment be initiated?

43

(10)

Patients at less than 20% risk of a major cardiovascular event in the next 10 years 44

Patients with established vascular disease or at high risk of developing it (> 20% 10-year cardiovascular risk)

44

(9)

4 Is non-drug treatment worthwhile?

53

(6)

Evidence

54

(2)

Non-drug measures and antihypertensive medication

56

(3)

5 How far should BPs be lowered?

59

(6)

6 What drug treatment should be used

65

(30)

Trial evidence as of 1993/94

66

(1)

Benefits of more contemporary drugs over standard therapy

67

(11)

What is the optimal pair of BP-lowering agents?

78

(5)

Which drugs are best for different sub-groups of patients?

83

(12)

7 What concomitant therapy is needed?

95

(6)

Which patients with hypertension merit lipid-lowering therapy?

96

(1)

ALLHAT--LLT and ASCOT-LLA studies

97

(1)

Which patients with hypertension should receive aspirin?

98

(1)

Which patients with hypertension should receive antioxidant therapy?

98

(3)

8 How to improve BP control

101

(8)

How well is BP treated and controlled?

102

(1)

Why is hypertension managed so inadequately?

102

(3)

Can we improve BP control?

105

(4)

9 What are the prospects for the future?

109

(10)

What don't we know?

110

(1)

Flow to improve implementation of guidelines

111

(2)

Will more effective modification become available?

113

(2)

Population vs high-risk strategy

115

(4)

Index

119

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Current Issues in Hypertension

Summary

Table of Contents

Supplemental Materials