577
Index
Note: Page numbers followed by the letter f refer to figures and those followed by t refer to tables.
A Coronary Disease Trial Investigating Outcome with
Nifedipine Gastrointestinal Therapeutic System
(ACTION), 272t, 273, 281
AASK. See African American Study of Kidney Disease
and Hypertension (AASK).
AB/CD rule, for treatment decisions, 506, 575
ABCD-HT (Appropriate Blood Pressure Control in
Diabetes-Hypertension), 271, 272t, 280, 319t,
353t, 354f
Abdominal obesity, 370
insulin resistance associated with, 418–419
resistant hypertension and, 509
Abdominal surgery, for pheochromocytoma resection,
128
ABI. See Ankle-brachial index (ABI).
Ablation therapy, radiofrequency, for metastatic
pheochromocytoma, 129
ABPM. See Ambulatory blood pressure monitoring
(ABPM).
Abruptio placentae, with chronic hypertension, 431
Absolute risk
of cardiovascular disease, 7, 8f
of hypertension, 3
of renovascular hypertension, 95, 95f
Accelerated hypertension. See also Malignant
hypertension.
natural history of, 165
ACCESS (Acute Candesartan Cilexetil Evaluation in
Stroke Survivors), 258, 259f, 399
Access to care, as blood pressure control factor, 527
Acculturation
of African Americans, 468
of Hispanics, 483
of South Asians, 495
Accupril Titration Interval Management Evaluation
(ATIME) trial, 475
ACE gene
association studies on, 18, 19–20, 19t
pathophysiologic mechanisms of, 27
ACE-I. See Angiotensin I–converting enzyme (ACE-I).
ACE-II. See Angiotensin II–converting enzyme
(ACE-II).
ACE Inhibition in Progressive Renal Disease (AIPRD),
353, 353t, 354, 355
ACE inhibitors. See Angiotensin-converting enzyme
(ACE) inhibitors.
Acebutolol
elimination characteristics of, 234t
historical studies on, 306
molecular structure of, 232, 235f
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
Acetazolamide, 213, 225
Acetorphan, 298
Acid-base balance
in ectopic ACTH syndrome, 109–110
thiazide diuretics effect on, 225
transplant hypertension and, 365
Acromegaly, 150
resistant hypertension related to, 500f, 504
ACTH. See Adrenocorticotropic hormone (ACTH).
ACTH suppression, for glucocorticoid-remediable
aldosteronism, 116
ACTH suppression test, for hypercortisolism diagnosis,
109–110
Actin, calcium channel blockers effects on, 268, 269f
ACTION (A Coronary Disease Trial Investigating
Outcome with Nifedipine Gastrointestinal
Therapeutic System), 272t, 273, 281
Action potential, cardiac membrane, β-adrenergic
blockers effect on, 231, 232t
Active/positive control group, in new drug
development, 540, 541, 541f, 542
Acute Candesartan Cilexetil Evaluation in Stroke
Survivors (ACCESS), 258, 259f, 399
Acute cellular rejection, in heart transplant, 347
Acute coronary syndromes
hypertension management with, 336–337
hypertensive emergency with, 517, 518, 518t
management of, 519
Acute hypertension, in children, 446, 446t
Acute hypertensive crises
with malignant pheochromocytoma, 129
with pheochromocytoma resection, 128
prevention of, 126–128
Acute Infarction Ramipril Efficacy (AIRE) study, 336,
343
Acute-phase response, to diuretics, 217, 217f
Additive effect, of gene-environment interactions, 22
Adducin gene, 27–28, 29
diet interactions with, 207
Adenoma
adrenal, resistant hypertension related to, 503
aldosterone-producing, 110
hyperplasia vs., 112–113, 148, 149
hypertension related to. See Primary
aldosteronism.
malignant transformation of, 115
Adenosine triphosphatase (ATPase), vascular tone and,
38
Adenosine triphosphate (ATP)-dependent calcium
pump, 268, 269f
Adenosine triphosphate (ATP)-sensitive potassium
channels, activation of, 299
ADH (antidiuretic hormone), diuretic therapy impact
on, 214f, 224f
Adherence, to treatment. See Nonadherence.
Adipose tissue, natriuretic peptide receptor
overexpression in, 42
Adiposity
excess, 194
hypertension related to, 477
resistant hypertension and, 509
Admixture mapping, of genetic patterns, 17, 20, 21f, 482
Admixture populations, genetic studies on, 17, 20, 21f,
482
Adolescents
blood pressure measurement in, 441
hypertension in, 440–454
by age percentiles, 440, 443t, 445t
by height percentiles, 440, 443t, 445t
by sex, 440, 443t, 445t
defining, 49–50, 50f, 54
essential, 446–447
characteristic findings of, 448
evaluation of, 447–449, 449f
diagnostic testing for, 448–449
medical history in, 447–448
physical examination in, 447–448
obesity trends and, 6, 207–208, 447
weight loss for, 449
practice standards for, 552, 553t
Adolescents (Continued)
secondary causes of, 441, 446
acute vs. chronic, 446t
target organ damage with, 447, 448, 449f, 450
substance use/abuse in, 446, 446t, 560
Adrenal adenoma, resistant hypertension related to, 503
Adrenal hyperplasia
aldosterone excess from. See Primary aldosteronism.
hypertension related to, 148–149
adenoma vs., 112–113, 149
congenital, 106
resistant hypertension related to, 503
Adrenal medulla
ACTH-producing tumors of, 109–110
aldosterone-secreting tumors of, 110, 112–113. See
also Primary aldosteronism.
catecholamine-secreting tumors of, 119. See also
Pheochromocytoma.
Adrenal veins, bilateral sampling of, for adrenal
adenoma localization, 113, 114f
Adrenalectomy
for ACTH-producing tumors, 110
for primary aldosteronism, 113–114
medical management guidelines, 115
laparoscopic, for pheochromocytoma, 128
Adrenergic agonists
central
for children and adolescents, 450, 451t
for pregnancy-related hypertension, 432, 433t
hypertension related to, 146
partial activity of, 231
Adrenergic antagonists. See also α-Adrenergic blockers;
β-Adrenergic blockers.
for obstructive sleep apnea syndrome, 140
pharmacogenetic studies of, 20, 32, 33
α-Adrenergic blockers, 286–292
adverse effects of, 292
chemical structures of, 289f
for diabetes-related hypertension, 410f, 411t, 413
for heart failure, 341
for hypertension, 288–292
angiotensin-converting enzyme inhibitors with, 243
cardiovascular events with, 289–291, 290f
CHEP 6 guidelines for, 562t, 565, 565f
clinical trial trends, 288–289, 292
considerations with, 231–232, 236, 288–289
diuretics vs., 220f–221f
in African Americans, 470
in children and adolescents, 450, 451t
peripheral, 450, 453t
in elderly patients, 459, 461, 463, 463t, 464
in obesity, 378–379, 380t
metabolic effects of, 291
for pregnancy-related hypertension, 433, 433t
for resistant hypertension, 506
for stroke prevention, primary, 395, 397
for transplant hypertension, 365, 365t, 366
guidelines for, international comparisons of, 574, 575f
historical studies on, 306
hypertension related to, 145
lipid-lowering drug interactions with, 420, 420t
pharmacology of, 287–288, 289f
preoperative, for pheochromocytoma resection, 126,
127
receptor subtypes and, 286–287, 287f
sympathetic nervous system physiology and, 286, 290
578 Index
β-Adrenergic blockers, 231–236
ambulatory blood pressure monitoring and, 89
elimination characteristics of, 234t
for angina
stable, 335
unstable, 336
for chronic kidney disease related hypertension, 356,
357t, 358
for coronary artery disease, 329, 331t
for diabetes-associated hypertension, 236, 406, 410f,
411t, 412–413
type 2 diabetes pathology and, 414
for heart failure, 342, 343, 344
for hypertension, 231–236
adverse effects of, 236
angiotensin-converting enzyme inhibitors with,
242–243
β1-selectivity of, 231, 232t
calcium channel blockers vs., 270, 271, 273f,
276–277
CHEP 6 guidelines for, 562t, 564t, 565, 565f
combination formulations of
with diuretics, 233–234, 236
with miscellaneous drugs, 236
contraindications to, 236
diuretic therapy vs., 219, 220f–221f, 225, 227
in black patients, 222
in elderly patients, 219, 222
in African Americans, 236, 468, 470, 496
in children and adolescents, 450, 451t–452t
in East Asian populations, 489
in elderly patients, 219, 222, 459, 461, 461t, 463,
463t
in obesity, 379, 380t
lipid-lowering drug interactions with, 420, 420t,
421, 424
list of approved, 231, 232t
mechanism of action, 232t, 233–234, 236
properties of, 231–233, 232t, 233t, 235f
for hypertensive emergencies, 518
for non-ST-segment myocardial infarction, 336
for perioperative hypertension, 513–514, 515
for peripheral arterial disease, 389
for pregnancy-related hypertension, 234, 432–433, 433t
for primary aldosteronism, 114
for resistant hypertension, 502, 506
for ST-segment elevation myocardial infarction, 336
for stroke prevention, primary, 395, 396, 396f, 397f
for transplant hypertension, 365, 365t
for vascular dementia, 401
guidelines for, international comparisons of, 574,
575, 575f, 575t
historical studies on, 306
hypertension related to, 145
JNC 7 guidelines for, 556–557, 556t, 557f
meta-analyses of, 318, 319t, 321f, 322
metabolism of, 234t
molecular structure of, 232, 235f
outcome studies on, 307, 309
peripheral resistance and, 33
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t, 234t,
235f
plasma levels of, 233t
preoperative, for pheochromocytoma resection, 126,
127
regulatory development of, 543, 544, 545
with α1-adrenoceptor antagonist activity, 288
α-Adrenergic receptors
imidazoline agonists targeting, 297–298, 297f, 298t
obesity-related hypertension and, 379
subtypes of, 286
β-Adrenergic receptors
candidate genes of, 19t
subtypes of, 286
Adrenocortical enzyme deficiency, hypertension related
to, 106–108, 108f
Adrenocorticotropic hormone (ACTH). See also
Corticotropin.
ectopic excess of
Cushing’s syndrome resulting from, 109–110
pituitary excess vs., 110
for renal potassium-wasting disorders, 107t
in glucocorticoid-remediable aldosteronism,
115–116, 116f
Adrenocorticotropic hormone (Continued)
in glucocorticoid resistance, 108
overproduction of, 107–108
Adrenomedullin, mediating role of, 26f, 43
α1-Adrenoceptor antagonists, 286
for hypertension, 288–292
clinical trial trends, 288–289, 292
for Raynaud’s phenomenon, 288, 292
α1-Adrenoceptors
molecular activation of, 286–287, 287f
postsynaptic blockade of, selective, 287
uroselective, 286, 288, 291, 292
Adult Treatment Panel, Third (ATP III), of National
Cholesterol Education Program, 158, 406, 418,
419t, 423
Adults
defining hypertension in, 49–50, 50f
treatment guidelines for. See Clinical practice
guidelines (CPGs).
Adverse clinical events, in untreated hypertension,
157–164
aortic dissection as, 164
cardiovascular death as, 161–162, 162f
heart failure and, 162–163
ischemic heart disease and, 157–159, 158f–159f
natural history of, 155–157, 156f, 166
peripheral vascular disease and, 164
renal failure and, 163–164, 163f
stroke and, 159–161, 160f–161f
vascular dementia and, 164
Adverse drug interactions
with angiotensin II receptor blockers, 256
with diuretics, 227
Adverse effects
no-observed level of, 537
of α-adrenergic blockers, 292
of calcium channel blockers, 273, 274t, 275, 275f
of diuretics, 223–226
Advisory Committee, Cardiovascular and Renal Drugs,
538, 544, 546
Aerobic exercise, for weight loss, 374, 376, 377t
Affluence, as risk factor, in India population, 495
African American Study of Kidney Disease and
Hypertension (AASK), 244, 272t, 309–310, 319t
chronic kidney disease in, 353t, 354, 354f, 356, 357
lessons learned from, 476–477
African Americans, hypertension in, 468–479
clinical trials and, 474–477
monotherapies, 468, 469f, 475, 477–478
coronary heart disease risk estimation in, 195–196
definition for, 49–50, 50f
detection disparities with, 468, 483–484, 483t
dietary trials in, 208
DASH, 205
potassium intake increase, 204
sodium intake reduction, 203, 203f
dyslipidemia and, 196, 418
epidemiology of, 468–469
genetic studies and, 16, 17, 19t, 21–22, 42
admixture mapping, 20, 21f, 482
hemodynamic tendencies with, 469–470, 469t
home blood pressure monitoring impact on, 80
low birth weight and, 472
mortality trends of, 58, 156, 161, 469
neurohumoral tendencies with, 469t, 470, 471–472
pathophysiology of, 469–474
common “tendencies” in, 469–470, 469t
diurnal blood pressure variation, 469t, 470
endothelin in, 469t, 471
natriuretic hormones in, 469t, 471
plasma volume and, 469t, 470
renin-angiotensin system and, 469t, 470–471
salt sensitivity and, 469t, 471–472
sympathetic nervous system activity, 469t, 470,
471, 472, 473f
transforming growth factor-β in, 469t, 471
vascular function and, 469t, 472
pharmacotherapy for, 477–479, 478f
α-adrenergic blockers in, 470
β-adrenergic blockers in, 236, 468, 470, 496
angiotensin-converting enzyme inhibitors in, 242,
247, 475, 496, 565
quinapril response distributions, 468, 469f, 475
angiotensin II receptor blockers in, 468
attenuated nocturnal BP decline and, 478–479
African Americans, hypertension in (Continued)
calcium channel blockers in, 270, 468, 475, 496
diuretics in, 222, 475–476, 496
goals of, 478
intravascular volume limitation, 478, 478f
monotherapies, 468, 469f, 475, 477–478
racial differences in, 478
physiologic tendencies with, 469–470, 469t
post-transplant, 363–364
preterm birth and, 472
prevalence trends of, 4, 4t, 6, 482
in Africa, rural vs. urban, 468
in U.S., age and sex adjustments for, 468
renal injury mechanisms with, 472–474, 473f
renin-angiotensin system antagonists, 476–477, 479
secondary, 469
target organ injury and, 469
therapeutic considerations for
diet modifications, 477
drugs as, 477–479, 478f
exercise as, 477
lifestyle modifications, 477
response distributions, 468, 469f
treatment disparities in, 483–484, 483t, 484f
weight loss as, 477
Afterload, cardiac
in isolated systolic hypertension
elevation of, 164–165, 173
therapeutic reduction of, 174
in left ventricular hypertrophy, 179
aging impact on, 340–341
obesity and, 372
preeclampsia and, 436
Age/aging
aortic pressure profile resulting from, 327–328, 329f
as risk factor, 5, 5f
diet influence on, 201, 202f, 207–208
epidemiology of, 169, 170f
in U.S. population, 12–13, 13t
blood pressure staging and, 7
coronary heart disease relationship to, 171, 171f,
330f
therapeutic goals for, 174–175
calcium channel blockers and, 270
chronic kidney disease and, 185
global cardiovascular risk and, 190, 192, 193f
home blood pressure monitoring and, 72
hypertension and
definition based on, 49–50, 50f
heart failure mechanisms with, 340–341
isolated systolic hypertension and, 169, 170f
target goals based on, 174–175
new drug development and, 539
obstructive sleep apnea syndrome and, 135, 136,
136t, 137f
perioperative hypertension and, 513t
peripheral artery disease prevalence based on, 384, 385f
stroke mortality adjusted for, 393–394, 393f
stroke risk based on, 394, 394f, 396, 396f
Age percentiles, for children, blood pressure levels for,
440, 442t–445t
Agency for Healthcare Research and Quality (AHRQ),
552
AGT. See Angiotensinogen (AGT).
AHA. See American Heart Association (AHA).
AHA (anterior hypothalamic area), in salt-sensitive
hypertension, 31–32, 32f
AHI (apnea-hypopnea index), in sleep disorders, 134,
135, 136, 137f
AHIP (America’s Health Insurance Plans), 552
AHRG (Agency for Healthcare Research and Quality),
552
AIPRD (ACE Inhibition in Progressive Renal Disease),
353, 353t, 354, 355
AIRE (Acute Infarction Ramipril Efficacy) study, 336, 343
Aladotril, 298
Alaskan Natives
low birth weight in, 472
mortality trends of, 161
Albumin-to-creatinine ratio, in chronic kidney disease,
354–355, 355t
Albuminuria
angiotensin-converting enzyme inhibitors and, 244,
245
as cardiovascular death risk factor, 355, 355f

Albuminuria (Continued)
in chronic kidney disease, 186, 186t, 351
hypertension management and, 357–358
treatment goals for, 354–355
obesity and, 379
Alcohol intake
blood pressure response to, 204
CHEP 6 guidelines for, 564
coronary heart disease and, 193–194
home blood pressure monitoring and, 73, 73t
hypertension related to, 6, 147, 566
in elderly patients, 459, 459t
obesity and, 372
obstructive sleep apnea syndrome and, 136, 136t
resistant hypertension related to, 508, 508t
transplant hypertension and, 364
Aldosterone
acromegaly impact on, 150
atrial natriuretic peptide and, 42
diuretic therapy impact on, 214f, 215, 216
adaptive, 223, 224f, 225
hypertensive syndromes related to
excessive production, 110–116. See also
Aldosteronism.
mineralocorticoid receptors and, 108–109, 109f
kidney disease role, 351, 356
obstructive sleep apnea syndrome and, 138, 138f
pathophysiologic role of, 39–40, 40f, 295
genetic mechanisms in, 26f, 28f
renin and. See Renin-angiotensin-aldosterone system
(RAAS).
resistant hypertension related to, 501t, 502–503
vascular tone experiments in, 33–34
zona fasciculata regulation of, 115, 116f
Aldosterone-producing adenoma, 110
hyperplasia vs., 112–113, 148, 149
hypertension related to. See Primary aldosteronism.
malignant transformation of, 115
Aldosterone receptor antagonists, 40, 115
adverse effects of, 225
CHEP 6 guidelines for, 564t, 565, 565f
for elderly patients, 461t
for heart failure, 344
for isolated systolic hypertension, 174
JNC 7 guidelines for, 556–557, 556t, 557f
new investigations on, 295–296
Aldosterone synthase, in glucocorticoid-remediable
aldosteronism, 115, 116f
Aldosterone-to-renin ratio, 110
Aldosteronism
antagonistic drug therapy for, 295–296. See also
Aldosterone receptor antagonists.
glucocorticoid-remediable, 115–116, 116f
primary
adenoma vs. hyperplasia differentiation, 112–113
clinical recognition of, 110
diagnosis of, 110, 112f, 112t, 113t
simplified approach to, 113, 114f
hypertension related to, 107t, 110–115
in African Americans, 469, 469t, 470
in resistant hypertension, 500f, 501t, 502–503
localizing procedures for, 113, 114f
screening tests for, 110, 111f–112f, 113t
therapeutic choices for, 113–115, 114f–115f
Alfuzosin, 288, 289f
Aliskiren, 299
Alkalosis, hypokalemic, in ectopic ACTH syndrome,
109–110
Alleles
ANP gene variants of, 42
D, of ACE gene, 27, 29
I, 29
Trp460, 27–28
Allergy(ies), to diuretics, 227
ALLHAT. See Antihypertensive and Lipid-Lowering
Treatment to Prevent Heart Attack Trial
(ALLHAT).
Allograft vasculopathy, cardiac, 348
Allografts. See Transplant hypertension.
ALPINE (Antihypertensive Treatment and Lipid Profile in
a North of Sweden Efficacy Evaluation), 411t, 414
Alternative medicine, complementary and, ethnic use
of, 485, 489
Alzheimer’s dementia, 164, 170, 401
angiotensin-converting enzyme inhibitors effects on,
248, 248f
Alzheimer’s dementia (Continued)
blood pressure and
as risk factor, 164, 401
treatment trials for reducing, 401–402, 402f
Ambulatory blood pressure monitoring (ABPM), 85–91
blood pressure classifications and, 53–54, 54t
circadian variation in
early morning surge and, 86
nighttime dipping and, 85–86, 86f
transplant hypertension and, 362–363, 363f
devices for, 90
validation protocol for, 90–91
for hypertension management, 87–90
algorithm for, 87–88, 88f
impact on treatment advances, 88–89, 89t
self-monitoring and, 88
utility of, 89–90, 90t
for left ventricular hypertrophy assessment, 180
for pregnancy-related hypertension, 430
guidelines for
CHEP 6, 561
international comparisons of, 571, 572t
JNC 7, 555
WGTF 4, 558, 560, 561
home monitoring and, 69, 77
correlations between, 75–76
in children and adolescents, 441
in clinical trials
chronotherapeutic agents assessment, 89–90, 90t
chronotherapeutic agents delivery systems and, 90
data analyses of, 88–89, 89t
different drug class comparisons, 89
same drug class comparisons, 89
in elderly patients, 458
in new drug development, 543
in perioperative period, 515
nurse-pharmacist collaboration and, 531
prognostic value of, 86, 87f
white-coat hypertension and, 86–87
white-coat normotension and, 87
AME (apparent mineralocorticoid excess), syndrome of,
17t, 26f, 27t, 28f
American College of Cardiology
on cardiovascular complication predictors, 512, 513t
on heart failure, 181, 342, 342f
perioperative hypertension management guidelines,
514, 515
American Diabetes Association, blood pressure control
standards of, 192, 527
American guidelines, for clinical practice. See United
States guidelines.
American Heart Association (AHA)
blood pressure measurement guidelines of, 58, 59,
551
for home monitoring, 69, 76, 458
for improvement strategies, 59, 60
definition recommendations, 54, 54t
on cardiovascular complication predictors, 512, 513t
on heart failure, 181, 342, 342f
perioperative hypertension management guidelines,
514, 515
Pooling Project of, 155
stroke prevention recommendations, 248
American Medical Association, 552, 552t
American Society of Hypertension
definition recommendations, 54, 85
on home blood pressure, 458
upper limits for, 76
Americans. See United States.
America’s Health Insurance Plans (AHIP), 552
Amiloride
adverse effects of, 225
clinical trials on, 26
for aldosteronism, 114, 116
for children and adolescents, 450, 453t
pharmacokinetics of, 214t, 216
Aminoglycosides, nephrotoxicity of, diuretics and, 227
Amlodipine
ambulatory blood pressure monitoring for, 89
angiotensin-converting enzyme inhibitors with, 243,
259, 260
clinical trials on, 55, 219, 222, 258
outcome-based, 272t, 276t, 279, 307
for chronic kidney disease, 356
for diabetes-related hypertension, 411t
for heart failure, 341–342
Index 579
Amlodipine (Continued)
for hypertension
elderly patients, 459
in African Americans, 475, 476
in children and adolescents, 450, 452t
in East Asian populations, 489
in Hispanic populations, 485
for stroke prevention, 397
for transplant hypertension, 365t, 366
historical studies on, 306
home monitoring evaluation of, 70f, 79
pharmacokinetics of, 269
regulatory development of, 545
Amphotericin B, hypertension related to, 148
Amputations, peripheral arterial disease and, 387
Anabolic steroids, resistant hypertension related to,
500f, 507, 508t
ANBP-1 (Australian National Blood Pressure trial no. 1),
159, 159f, 164
ANBP-2 (Australian National Blood Pressure trial no. 2),
311, 319t
Ancestral populations, genetic studies of, 17
Androgens
adrenocortical enzyme deficiency impact on,
106–108, 108f
oral, hypertension related to, 145
synthesis pathway of, 108f
Anemia
angiotensin-converting enzyme inhibitor-induced,
249–250
angiotensin II receptor blockers causing, 264
bariatric surgery and, 378
hemolytic, 518
Aneroid sphygmomanometer, 59
calibration of, 60, 60f, 61
inspection for quality assurance
ambulatory monitoring and, 90–91
in office, 66
Anesthesia/anesthetics
for pheochromocytoma resection, 128
hypertension related to, 145
perioperative hypertension related to, 514, 515
Aneurysms
aortic, 162
intracerebral, 160
micro-, in hypertensive retinopathy, 184, 185t
renal artery, renovascular hypertension with, 94
Angina pectoris (AP)
assessment of, 179t, 180
calcium channel blockers and, 273, 281
chronotherapeutic treatment of, 89–90
circadian patterns of, 89
diagnostic workup for, 334
hypertension management with
CHEP 6 guidelines for, 564t
stable, 334–335
unstable, 336
hypertension risk for, 9f
perioperative hypertension and, 512, 513, 513t
management of, 514–515, 515f
Angioedema
angiotensin-converting enzyme inhibitor-induced,
249, 250f
angiotensin II receptor blockers causing, 264
Angiogenesis, in preeclampsia, 430f, 435
Angiography
cerebral, for stroke assessment, 184
computed tomography, for renal disease, 95–97
performance characteristics of, 97t, 99–100
resistant, 501t, 502
coronary
for angina assessment, 335
for ischemic heart disease assessment, 180
magnetic resonance. See Magnetic resonance
angiography (MRA).
of peripheral artery disease, 387
renal. See Renal angiography.
Angioplasty, balloon, for renovascular hypertension, 94,
101–102
clinical trials on, 102–103
resistant, 501t, 502
stenting plus, 102, 501t
Angiotensin-converting enzyme (ACE) inhibitors,
239–250
angiotensin II receptor blockers combined with
clinical trials on, 259–262, 259f, 263–264
580 Index
Angiotensin-converting enzyme (ACE) inhibitors
(Continued)
diabetes and, 257–258, 265
meta-analysis of, 265, 265f
side effects of, 264
calcium channel blockers and, 242, 243, 270, 271,
273f, 276–277
CHEP 6 guidelines for, 562t, 564t, 565, 565f
clinical trials on, 102–103, 159f, 162, 219
end-organ effects and, 244–248
recent, 244–248
dihydropyridine. See Dihydropyridines.
diuretics vs., 219, 222, 225
end-organ effects of, 244–248
cardiac, 246–247
renal, 163–164, 244–246, 245f, 246t
stroke and, 247–248, 248f
end-stage renal disease and, 163–164, 163f
clinical trials on, 244–246, 245f, 246t
endothelin antagonists combined with, 296–297
for angina
stable, 335
unstable, 336
for arterial stiffness, 36–37
for cardiac disorders, 239, 240, 240t, 242, 243
for chronic kidney disease, 353, 353t, 354, 355–356
hypertension management and, 357–358, 357t
for coronary artery disease, 330, 331t–332t, 332
for diabetes-associated hypertension, 242, 244–245,
244f, 406, 408, 409, 410–411, 410f, 411t
type 2 diabetes pathology and, 414
for heart failure, 341–344, 343f–344f
for hypertension, 239–250
and dyslipidemia, 422, 422t, 424
class effect in, 240–241
combinations with other agents, 242–243
dosage and treatment guidelines for, 239, 240t,
242
evidence-based benefits of, 240–241
in African Americans, 242, 247, 475, 496
quinapril response distributions, 468, 469f, 475
in children and adolescents, 450, 451t
in East Asian populations, 489, 490
in elderly patients, 459, 461, 461t, 463, 463t
in Hispanics, 484, 485
in obesity, 378, 379, 380t
in South Asian populations, 496
JNC 7 guidelines for, 556–557, 556t, 557f
list of approved, 239, 240t, 242
mechanism of action, 241–242, 241t
properties of, 239–241
response rates, 242
WGTF 4 guidelines for, 560
for hypertensive emergencies, 518
for metabolic syndrome, 422, 422t
for non-ST-segment myocardial infarction, 336
for perioperative hypertension, 514, 515
for peripheral arterial disease, 243, 389
for pregnancy-related hypertension, 248–249, 431,
433t, 434–435
for renal arteriopathy, 33
for renovascular hypertension, 94, 102–103
for resistant hypertension, 500, 501t, 502, 503, 508,
509
in multidrug program, 505–506, 505f
for ST-segment elevation myocardial infarction, 336
for stroke prevention
primary, 395, 396, 396f, 397, 397f
secondary, 398
for systolic hypertension, 243
isolated, 174
guidelines for, international comparisons of, 573,
574, 575, 575f
hemodynamic effects of, 241–242, 241t
historical studies on, 306
lipid-lowering drug interactions with, 420, 420t, 421
meta-analyses of, 318, 319t, 320f–321f, 322–323, 323f
metabolism of, 239
outcome studies on, 311c
peripheral vascular resistance normalization by, 33
pharmacology of, 239–241
application of differences in, 240–241, 254
elimination route, 239
tissue binding, 239–240
regulatory development of, 540, 542, 543, 544, 546
Angiotensin-converting enzyme (ACE) inhibitors
(Continued)
renin inhibitors and, 299
sensitivity to, 38
side effects of, 248–250
transplant hypertension and, 364, 365, 365t, 366
Angiotensin-converting enzymes
chronotherapeutic treatment and, 89–90
digestion susceptibility of, 38
gene coding for, 246
schematic representation of, 37–38, 37f
Angiotensin I, functional representation of, 37–38, 37f
Angiotensin I–converting enzyme (ACE-I)
catalytic actions of, 37–38, 37f, 254
functional representation of, 37, 37f
gene association studies on, 18, 19–20, 19t
gene mutations of, 27
Angiotensin II
angiotensin-converting enzyme inhibitors effects on,
241
diuretic therapy impact on, 213, 217, 224f
functional representation of, 37–38, 37f
in African Americans, 469t, 470–471
in renovascular hypertension, 94
kidney disease role, 351, 352
local production of, 39
obesity and, 372
pathophysiologic role of, 27, 30f, 34, 38–39
physiologic effects of, 254
receptor blockade for, 254–265. See also Angiotensin
II receptor blockers (ARBs).
Angiotensin II escape, 241
Angiotensin II receptor blockers (ARBs), 254–265
adverse effects of, 264
ambulatory blood pressure monitoring for, 89
angiotensin-converting enzyme inhibitors combined
with, 243, 254
clinical trials on, 259–262, 259f, 263–264
diabetes and, 257–258
meta-analysis of, 265, 265f
calcium channel blockers combined with, 258,
259–260, 263
differences among, clinical importance of, 256–257
diuretics combined with, 222, 256, 258, 259
drug interactions with, 256
FDA approved, 254, 255t
for chronic kidney disease, 356, 357–358, 357t
for coronary artery disease, 332–333, 332t
for diabetes-associated hypertension, 244, 245,
257–258, 265, 408, 409, 410f, 411–412, 411t
for heart failure, 342–344
for hypertension
CHEP 6 guidelines for, 562t, 564t, 565, 565f
in African Americans, 468
in children and adolescents, 450, 451t
in East Asian populations, 489, 490
in elderly patients, 461, 461t
in Hispanics, 484–485
in obesity, 379, 380t
in South Asian populations, 496
JNC 7 guidelines for, 556–557, 556t, 557f
WGTF 4 guidelines for, 560
for hypertensive emergencies, 518
for isolated systolic hypertension, 174
for metabolic syndrome, 422, 422t
for perioperative hypertension, 514, 515
for pregnancy-related hypertension, 431, 433t, 434
for renovascular hypertension, 94, 95, 96t, 102
clinical trials on, 102–103
for resistant hypertension, 501, 501t, 502, 503, 507, 509
in multidrug program, 505–506, 505f
for ST-segment elevation myocardial infarction, 337
for stroke prevention, primary, 395, 397
for transplant hypertension, 365, 365t, 366
guidelines for, international comparisons of, 573, 575f
mechanisms of action, 257–258
meta-analysis of, 257, 259f, 264–265, 265f
metabolism of, 256
outcome-based clinical trials on, 258–264
for cardiac disorders, 260–262
for cerebrovascular disorders, 263
for kidney disorders, 260
ongoing, 263–264
overview of, 258–260, 259f
peripheral vascular resistance normalization by, 33, 39
Angiotensin II receptor blockers (ARBs) (Continued)
pharmacology of, 254, 255t, 256–257
AT1 vs. AT2 receptor response to, 254, 256, 257
binding characteristics, 256
elimination differences, 256
metabolic effects, 256
regulatory development of, 540, 542, 543, 545
transplant hypertension and, 364
Angiotensin II-receptors
hormonal effects at, 39, 39f
subtypes of, 254, 257
Angiotensin II–converting enzyme (ACE-II)
catalytic actions of, 37–38, 37f
functional representation of, 37, 37f
gene association studies on, 18, 19–20, 19t
Angiotensin III, functional representation of, 37–38, 37f
Angiotensin IV, 254
functional representation of, 37–38, 37f
Angiotensin receptor blockers, meta-analyses of, 319t,
322, 322f
Angiotensinases, 38
Angiotensinogen (AGT)
gene association studies on, 18, 19, 19t
gene-diet interactions and, 207
pharmacogenetic studies of, 21
renin reaction with, 37
Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT),
330, 397, 420–421, 420t
Ankle-brachial index (ABI)
angiotensin-converting enzyme inhibitors effects on,
243
in peripheral arterial disease, 182–183, 384
hypertension contributing to, 386, 387
two-vessel criteria for, 387
Annuloplasty, mitral valve, for heart failure, 345–346
ANP. See Atrial natriuretic peptide (ANP).
ANP gene, allelic variants of, 42
Antagonizing substances, resistant hypertension related
to, 500f, 507–508, 508t
Anterior hypothalamic area (AHA), in salt-sensitive
hypertension, 31–32, 32f
Anthracycline exposures, angiotensin-converting
enzyme inhibitors for, 243
Antiatherogenic action, of calcium channel blockers,
278–279, 278f, 278t
Anticoagulant therapy
for angina, unstable, 336
for stroke prevention, 399–400, 400t
Antidepressant agents, hypertension related to, 146
Antidiuretic hormone (ADH), diuretic therapy impact
on, 214f, 224f
Antiemetic agents, hypertension related to, 145
Antihistamines, hypertension related to, 146
Antihypertensive and Lipid-Lowering Treatment to
Prevent Heart Attack Trial (ALLHAT), 306, 319t
α-adrenergic blockers in, 289–291, 290f
African Americans in, 475–476
chronic kidney disease in, 354, 354f
diabetic patients in, 408, 411t, 412, 413, 414
diuretics in, 461, 574
drug interaction findings of, 420–421, 420t
elderly patients in, 219, 222, 459–460, 461
Hispanics in, 484
obesity in, 378, 379
on angiotensin-converting enzyme inhibitors, 243,
244, 247
on calcium channel blockers, 272t, 275, 276t, 277, 341
on diuretics, 219, 221f, 226, 342, 408
in elderly patients, 219, 222
resistant hypertension in, 498, 505, 509
stroke in, 397, 408
Antihypertensive drug therapy
ambulatory monitoring evaluation of, 87–90
algorithm for, 87–88, 88f
impact on treatment advances, 88–89, 89t
self-monitoring and, 88
utility of, 89–90, 90t
CHEP 6 guidelines for, 562t–564t, 564, 565, 565f
clinical trials on. See Clinical trials.
for arterial stiffness, 36–37
for children, 449f, 450, 454t
WGTF 4 guidelines on, 559t, 560–561, 560f
for elderly patients, 458–463
clinical trials on, 159f, 458, 462t, 463t
for combined systolic-diastolic, 459–460, 459t
 Index 581

Antihypertensive drug therapy (Continued) Antiplatelet therapy Arterial stiffness (Continued)

for isolated systolic, 460–461, 460t
goals of, 461–463
initial agent choice in, 461, 461t
lifestyle modifications as, 458–459, 459t
pharmacologic treatment as, 159f, 459–465
for heart failure, 341–342
for isolated systolic hypertension
benefits of, 173
selection of, 174
target goals for, 173–174
factors for achieving, 174–175
for renovascular hypertension, 94, 95, 96t, 102
angioplasty vs., 102–103
surgery vs., 102
goals for
defining hypertension and, 51–52
for diabetic patients, 29, 54
for select patient groups, 54–55
historical studies on, 305–306
home monitoring evaluation of, 80–81
ambulatory monitoring and, 88
evidence of improvement, 80
in clinical practice, 74, 78–80
intensity of treatment guidance, 80
minimum number of readings, 79, 79f
of time course, 80
of trough-to-peak ratio, 72, 80
optimal treatment identification, 79, 79f
placebo effect immunity, 80, 80t
sample size advantage, 81
validity of, 78–79, 78f–79f
international comparisons of, 566, 572t, 573t, 575t
for first-choice drugs, 573–574, 574f–575f
for prehypertension, 572–573
for specific indications, 574
guideline effectiveness, 566–567
major agreements, 571, 572f
monotherapy vs. combination, 572t, 573t, 574, 574f
on other issues, 574–575
JNC recommendations for adults, 7, 53
medications for. See Pharmacotherapy.
mortality controversies regarding, 155
obesity and
advantages/disadvantages of selected agents,
378–380, 380t
weight loss and, 375, 376
parenteral, for emergencies, 519, 520t–521t
pharmacogenetic studies of, 20–21, 42
practice implications of, 23, 26, 28–29
post-transplant, 364–366, 365t
postoperative, for primary aldosteronism, 115
prospective studies of, 10
racial/ethnic perspectives of. See specific ethnicity,
e.g. South Asians.
regulatory development of, 535–546
ambulatory blood pressure monitoring in, 543
clinical efficacy in, 540–543, 541f
clinical pharmacology in, 538–540
dose interval in, 542
dose selection in, 542
dose titration in, 542–543
drug-drug interactions and, 537, 539, 545
effectiveness criteria, 535, 540
endpoints for, 535, 543, 546
exclusivity criteria, 546
FDA role, 535, 537–538, 543, 546
food effects and absorption in, 539
for fixed-combinations, 544, 544f
metabolism and elimination in, 539
outcome labeling claims and, 543–544
overview of, 536–538
pediatric patients and, 546
pharmacodynamics in, 539–540
pharmacokinetics in, 537, 538–539
safety in, 535, 537, 545–546
special populations and, 539
study designs for, 540–542, 541f
study populations for, 542
terminology for, 535
Web addresses for, 536, 536t
Antihypertensive Treatment and Lipid Profile in a
North of Sweden Efficacy Evaluation
(ALPINE), 411t, 414
Antineoplastic agents, hypertension related to, 146
for angina, unstable, 336
for peripheral artery disease, 388
for stroke prevention, 399, 400t
guidelines for, international comparisons of, 573
Antiviral agents
for HIV infection, hypertension related to, 148
triple-drug therapy with, 148
Anxiety
perioperative hypertension and, 512, 513, 513t
management of, 515–151, 515f
resistant hypertension related to, 500f, 504, 506
Aorta
assessment of, 182
coarctation of
hypertension related to, 148, 446, 448
resistant hypertension related to, 500f
pressure profile of, age-related, 327–328, 329f
wave reflection related to, 172
Aortic aneurysm, 162
Aortic arch, mechanoreceptors in, 29, 30f, 31f
resetting of, 32
Aortic dissection
hypertensive emergency with, 517, 518, 518t, 519
management of, 519
in untreated hypertension, 164
renovascular hypertension with, 94
Aortic impedance, characteristic, 182
Aortic stenosis
angiotensin-converting enzyme inhibitors for, 243
systolic blood pressure and, 234
Aortoiliac lesions, in peripheral arterial disease, 387, 387t
AP. See Angina pectoris (AP).
AP (area postrema), sympathetic activity of, 30–31, 31f
Apnea
sleep-related, 134–141. See also Sleep apnea.
sympathetic nervous system response to, 32
Apnea-hypopnea index (AHI), in sleep disorders, 134,
135, 136, 137f
Apolipoprotein B, as coronary heart disease marker, 195
Apolipoprotein E, dyslipidemia and, 421
Apparent mineralocorticoid excess (AME), syndrome
of, 17t, 26f, 27t, 28f
Appropriate Blood Pressure Control in Diabetes-
Hypertension (ABCD-HT), 271, 272t, 280,
319t, 353t, 354f
Aprikalim, 299
ARBs. See Angiotensin II receptor blockers (ARBs).
Area postrema (AP), sympathetic activity of, 30–31, 31f
Area under the curve (AUC), of drug exposure, 538
ARIC (Atherosclerosis Risk in Communities), 195–196,
386, 387
Arm circumference, measuring of
for blood pressure cuff size, 62, 62t
importance of, 144, 561
in children and adolescents, 441, 558
Arm monitors, for home blood pressure monitoring,
70, 71f
Arm position
for blood pressure cuff placement, 62–63, 66
for blood pressure measurement, 63, 63f, 64, 66
Arm selection, for blood pressure measurement, 63, 66
Aromatic ring structures, of β-adrenergic blockers, 232,
235f
Arousal, obstructive sleep apnea syndrome and,
136–137, 137f, 139
Arousal index, in sleep disorders, 134
Arrhythmias, cardiac. See Dysrhythmias.
Arterial blood pressure, sympathetic nervous system
regulation of, 286
Arterial compliance, 327, 329f
aging impact on, 340
Arterial distensibility, decreased, 36–37, 36f
Arterial stiffness
aortic pressure profile resulting from, 327–328, 329f
as hypertension hallmark, 327, 329f
assessment of, 182–183
blood pressure measurement problems with, 144
calcium channel blockers effect on, 279–280
diabetes mellitus and, 169, 408–409, 409f
etiology of, 171–172
in isolated diastolic hypertension, 169, 170f
in isolated systolic hypertension, 169, 170f
antihypertensive drugs for, 174
kidney disease role, 351–352
left ventricular hypertrophy and, 179
pathophysiology of, 32, 36–37, 36f
accelerated, 169
Arterial tree, compartments of, 181–182
Arterioles, 182
peripheral resistance determined by, 33
Arteriopathy
hypertensive
arterial compartments and, 182–183
arteriosclerosis as, 182
assessment of, 182–183
ankle-brachial index for, 182–183
augmentation index for, 182
large arterial stiffness indicators, 182
atherogenesis as, 182
renal, uric acid and, 35–36
Arteriosclerosis. See also Atherosclerosis.
assessment of, 182–183
definition of, 182
Arteriosclerosis obliterans, peripheral artery disease
associated with, 385
Arteritis, Takayasu’s, 148
renovascular hypertension with, 94
Artery(ies)
baroreceptors of, 29, 30f, 31f
blunting of, 32
resetting of, 32
sensitivity factors of, 32
brachial. See Brachial artery.
calcification of, in elderly, 144, 171, 458
carotid. See Carotid arteries.
central (large), 181, 182
cerebral
infarction of large, 183
occlusion of, 392, 393f
perfusion of, autoregulation of, 399
stroke pathology of. See Stroke/stroke mortality.
coronary
disease of. See Coronary heart disease (CHD).
heart failure impact on, 341
perfusion pressure for, 333–334, 333f
femoral, peripheral artery disease in, 385
for blood pressure measurement, 62, 64, 66
technical problems with, 144, 172
iliac
peripheral artery disease in, 385
stenosis of, transplant hypertension and, 364
large
calcium channel blockers effects on, 279–280
central, 181, 182
cerebral, infarction of, 183
muscular conduit, 181, 182
peripheral. See Peripheral arterial disease (PAD).
peroneal, peripheral artery disease in, 385
popliteal, peripheral artery disease in, 385
radial, blood pressure measurement and, 64, 66
in elderly, 144
remodeling of. See also Vascular remodeling.
for isolated systolic hypertension, 174
renal. See Renal artery.
small, 181, 182
stenosis of, transplant hypertension and, 364
stretch receptors in, 29, 30f, 31f
systemic system of, tubular models of, 36, 36f
tibial, peripheral artery disease in, 385
umbilical, catheters for infants, 446
ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial),
330, 397, 420–421, 420t
Asia Pacific Cohort Studies Collaboration, 172
Asian Americans. See also East Asians; South Asians.
low birth weight in, 472
Aspirin
angiotensin-converting enzyme inhibitors
interaction with, 241
for angina, unstable, 336
for dyslipidemia, 422, 422t, 424
for preeclampsia, 435
for stroke prevention, 399, 400, 400t
guidelines for, international comparisons of, 573
Assessment, of hypertension. See also Diagnosis.
blood pressure in. See Blood pressure
measurement/monitoring.
guidelines for, international comparisons of,
571–575, 572t, 573t, 575t
582 Index
Association for the Advancement of Medical
Instrumentation, 61
ambulatory monitor testing protocols of, 90–91
home monitor testing protocols of, 70, 70t
Association studies, of genetics, 17, 18–20, 19t
computational methods for, 29
Astemizole, 539
Asthma, β-blocker cautions with, 231, 236, 506
ASTRAL trial, on renal angioplasty, 103
AT1AR receptors, vascular tone and, 33, 38–39
AT1R receptors
activation of, stimulation events following, 38–39, 38f
selectivity of, 38, 39f
AT2R receptors
regulation of expression of, 39
vascular tone and, 38–39
Ataxic-hemiparesis, 183
Atenolol
ambulatory blood pressure monitoring for, 89, 90
angiotensin-converting enzyme inhibitors with, 243
breast milk concentrations of, 437
diuretics vs., 219, 227
elimination characteristics of, 234t
for chronic kidney disease, 353t
for diabetes-related hypertension, 411t, 412–413
for heart failure, 342
for hypertension
in African Americans, 475, 476
in children and adolescents, 450, 452t
in East Asian populations, 489
for isolated systolic hypertension, 174
for peripheral arterial disease, 389, 390
for transplant hypertension, 365t
molecular structure of, 232, 235f
outcome studies on, 272t, 309, 310
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
Atherogenesis, 182
assessment of, 182–183
calcium channel blockers protection against,
278–279, 278f, 278t
dyslipidemia associated with, 7, 8f, 12, 29, 39, 419.
See also Dyslipidemia.
renin-angiotensin system promotion of, 419, 419f
Atheroma, carotid, stroke related to, 394
Atherosclerosis
assessment of, 182–183
impact on blood pressure measurement, 63, 144
in children and adolescents, 447
in elderly patients, 457
in postmenopausal women, 423
isolated systolic hypertension and, 173
Multi-Ethnic Study of, 195
obstructive sleep apnea syndrome and, 138, 138f
prognostic consequences of, 139, 139f
pathophysiology of, 36, 39
peripheral artery disease associated with, 385
prevention trials on, 159f
renovascular hypertension with, 94
angioplasty for, 101–102
clinical trials on, 102–103
stenting plus, 102
medical management of, 102
resistant hypertension related to, 507
renal, 500–502, 501t
stroke related to, 392, 393f, 394
treatment indications for, 423
vessels commonly affected by, 182–183
Atherosclerosis Risk in Communities (ARIC), 195–196,
386, 387
Atherothrombosis, of large arteries, 183
diagnosis of, 184
ATIME (Accupril Titration Interval Management
Evaluation) trial, 475
Atorvastatin
antihypertensive drug interactions with, 420, 420t
regulatory development of, 545
ATP. See Adenosine triphosphate entries.
ATP III (Adult Treatment Panel, Third), of National
Cholesterol Education Program, 158, 406, 418,
419t, 423
ATPase (adenosine triphosphatase), vascular tone and, 38
Atrial fibrillation
angiotensin II receptor blockers prevention of, 257
blood pressure measurement and, 64
Atrial fibrillation (Continued) Benazepril, 240t, 243
hypertension risk for, 7 clinical trials on, 245
in older individuals, 13, 13t for children and adolescents, 450, 451t
stroke prevention for, 399–400, 400t pharmacology of, 239
Atrial myocyte, natriuretic peptide expression by, 42, 42f Bendrofluazide, 227, 258, 306
Atrial natriuretic peptide (ANP) BENEDICT (Bergamo Nephrologic Diabetes
baroreflex sensitivity of, 32 Complications Trial), 280–281, 355
expression of, 42, 42f Benign prostatic hyperplasia (BPH), α1-adrenoceptor
inhibitors of, for hypertension, 298, 299f antagonists and, 286, 288, 291
mediating role of, 41–42, 41f Benzodiazepines, 268–269, 270t
obesity and, 371f, 372 Bergamo Nephrologic Diabetes Complications Trial
relative deficiency of, 42 (BENEDICT), 280–281, 355
Atrioventricular (AV) node, in heart failure Best Pharmaceuticals for Children Act (BPCA) of 2002,
electrical therapy for, 344–345 546
heart transplant and, 347 β-Blockers. See β-Adrenergic blockers.
Atrium(a) Betaxolol
heart transplant and, 347 elimination characteristics of, 234t
in heart failure, 340–341 pharmacodynamic properties of, 231–232, 232t
Attributable risk, of hypertension, 3 pharmacokinetic properties of, 232–233, 233t
AUC (area under the curve), of drug exposure, 538 Between-observer differences, in blood pressure
Auditory skills, for blood pressure measurement, 60, measurement, 59, 59f
60f, 61 Bias
Augmentation index, in arterial assessment, 182 observer, in blood pressure measurement, 64–66
Auscultation, in blood pressure measurement, 64, 441, form for evaluating, 64, 65f
551, 558 prevention of, in outcome studies, 310–311, 310f, 311t
Auscultatory devices, for blood pressure measurement. Binding, in pharmacodynamics. See Tissue binding.
See also Stethoscope. Binswanger’s disease, in untreated hypertension, 156f,
ambulatory, 90 165, 401
Auscultatory gap, 144 Bioavailability, of β-adrenergic blockers, 233t
cuff inflation for avoiding, 63–64 dose-dependent, 233t
Australian National Blood Pressure trial no. 2 (ANBP-2), Biochemical characteristics
311, 319t of hypercortisolism, 149
Australian National Blood Pressure trial no. 1 (ANBP-1), of obstructive sleep apnea syndrome, 135, 136t
159, 159f, 164 Biopsy(ies)
Australians endomyocardial, post-transplant, 347, 348
elderly patient trials on, 459, 459t of kidney allograft, 364
mortality trends of, 156 Birth defects, angiotensin II receptor blockers causing,
Autonomic dysreflexia, resistant hypertension related to, 264
500f, 504 Birth weight
Autonomic nervous system blood pressure relationship to, 440, 447
diabetes-related hypertension and, 413 low, in African Americans, 472
obstructive sleep apnea syndrome and, 137, 137f, 140 Bisoprolol, 236
renin-angiotensin-aldosterone system interactions ambulatory blood pressure monitoring for, 89
with, 29, 30f elimination characteristics of, 234t
vascular smooth muscle cell regulation by, 286 for children and adolescents, 450, 452t
Autoregulation, of cerebral artery perfusion, 399 for heart failure, 344
AV (atrioventricular) node, in heart failure pharmacodynamic properties of, 231–232, 232t
electrical therapy for, 344–345 pharmacokinetic properties of, 232–233, 233t
heart transplant and, 347 regulatory development of, 545
Azathioprine, transplant hypertension and, 362 BKCa2+ (Ca2+-activated K+ channel), vascular relaxation
and, 33, 34f
Black widow spider venom, hypertension related to, 148
Blacks. See African Americans.
Balloon angioplasty, renal, for renovascular Bleeding, calcium channel blockers associated with, 275
hypertension, 94, 101–102 Blood-brain barrier, 30, 31f
clinical trials on, 102–103 Blood flow
resistant, 501t, 502 coronary
stenting plus, 102, 501t heart failure impact on, 341
Balloon dilatation, percutaneous, for coarctation of the perfusion pressure for, 333–334, 333f
aorta, 148 placental
Bariatric surgery, blood pressure response to, 378 alterations with preeclampsia, 430f, 435
Baroreceptors in chronic hypertension, 432
angiotensin-converting enzyme inhibitors effects on, renal. See Renal blood flow (RBF).
241 velocity measurements, in peripheral artery disease,
arterial, 29, 30f, 31f 386
blunting of, 32 Blood glucose
resetting of, 32, 128 β-blocker effects on, 236, 406
sensitivity factors of, 32 control of, in diabetic patients, 29, 406, 407
obstructive sleep apnea syndrome and, 137, diuretics effect on, 226
137f–138f postoperative monitoring of, with
CPAP application impact on, 140, 141f pheochromocytoma resection, 128
Baroreflex pathways, 29, 31f Blood pressure (BP)
failure of, resistant hypertension related to, 500f, 504, age impact on. See Age/aging.
509 arterial, sympathetic nervous system regulation of, 286
Bartter’s syndrome, 17t, 27t as stroke risk, 5, 7, 8f, 394
type III, 27t lowering for prevention of, 394–399
Basal ganglia, sympathetic activity of, 30f, 31f acute, 398–399
Behavioral intervention trials, on dietary changes, 202, benefits of, 394–395, 395f–396f
207 patient subgroup effects, 396, 396f
Behavioral modification, for weight loss, 372 primary, 394–397
Behavioral self-management, for dietary changes, 207 relative benefits of different regimens, 396–397,
Bell, of stethoscope 396f
knowledge assessment of, 66 risk reduction related to differences in,
placement of, 61–62, 64 396f–397f, 397
Bell-shaped curve, of normal home blood pressure, 76 secondary, 397–398, 398f
 Index 583

Blood pressure (BP) (Continued)
central nervous system control of, 29–31, 30f–32f
circadian variation of, 85–86, 86f
transplant hypertension and, 362–363, 363f
classification of, 6–7, 7t
JNC 7 guidelines for adults, 555
JNC system for, 6–7, 7t
paradigm shift for, 7
WGTF 4 guidelines for children, 558, 559t, 560–561
diastolic. See Diastolic blood pressure (DBP).
diet and
behavioral intervention trials on, 202, 207
effects of multiple changes, 207
evidence of influence, 201, 208–209, 208t
factors that reduce, 201–205
factors with limited effects, 205–207
gene interactions with, 203, 207
in special populations, 207–208
diurnal variations in. See Nocturnal entries.
end-stage renal disease progression and, 352, 352f
treatment goals related to, 352–354, 353f–354f
global cardiovascular risk and, 190–191
in children
body weight correlation to, 447
by age, sex, and height percentiles, 440, 442t–445t
in hypertension definition, 3
in newborns, 440
intra-arterial recordings of, 85
cuff measurements vs., 144
lowering of. See also Treatment.
as drug research endpoint, 535, 543, 546
measurement of. See Blood pressure
measurement/monitoring.
normal limits of
American Heart Association recommendations
for, 54, 54t
historical perspective of, 49
home vs. clinic, 76, 76t
international recommendations for, 53, 54t
JNC recommendations for, 53, 54, 54t
overestimation of, 144
peripheral perfusion stability and, 29–30
physiologic regulation of
pathways for, 19, 19t
pharmacogenetic studies of, 20–21
reflex control of, 29–30, 30f–31f
severe elevation of. See Hypertensive urgency(ies).
target organ damage with. See Hypertensive
emergency(ies).
sleep apnea impact on, 136–139, 137f–138f
CPAP application and, 140, 140f
sleep physiology and, 134
systolic. See Systolic blood pressure (SBP).
underestimation of, 144
Blood pressure cuff
accurate application of, 62–63, 62f
CHEP 6 guidelines for, 561
for children and adolescents, 441, 558
for elderly patients, 458
inflation range for, 63–64
knowledge assessment of, 66
sizes and arm circumference for
importance of, 144, 441, 558, 561
knowledge assessment of, 66
recommendations, 62, 62t
steps for properly using, 64
technical problems with, 144, 172
Blood Pressure Lowering Treatment Trialists’
Collaboration (BPLTTC), 317–323
applications of, 217, 271, 272t, 323
blood pressure risk and, 323, 323f
comparisons of active regimens and controls, 318,
Blood pressure measurement devices BPCA (Best Pharmaceuticals for Children Act) of 2002,
ambulatory, 90 546
validation protocol for, 90–91 BPH (benign prostatic hyperplasia), α1-adrenoceptor
calibration of, 66, 558 antagonists and, 286, 288, 291
CHEP 6 guidelines for, 561 BPLTTC. See Blood Pressure Lowering Treatment
for children and adolescents, 441 Trialists’ Collaboration (BPLTTC).
in home Brachial artery
choice of, 70, 71f blood pressure cuff placement over, 62, 64, 66
recommended, 70, 70t calcified, in elderly patients, 144, 171, 458
testing and validation of, 69–70 wave reflection related to, 172
in office Brachydactyly, hypertension with, 17t
accuracy validation for individuals, 61 Bradycardia, heart failure and, pacing indications for,
calibration of, 60–61, 60f 344–345
critical skills for use of, 60, 60f Bradykinin
inspection for quality assurance, 66 angiotensin-converting enzyme inhibitors, effects on,
Web site of, 61, 70, 91 241, 246, 249
Blood pressure measurement/monitoring obesity and, 379
ambulatory, 85–91. See also Ambulatory blood angiotensin receptor blockade and, 254, 264
pressure monitoring (ABPM). mediating role of, 26f, 42, 43
between-observer differences in, 59, 59f metabolism of, 37
brief history of, 58 Brain
errors in, diagnosing, 66, 66t acute hemorrhage of, 183
“gold standard” for, 59, 60–61, 60f angiotensin-converting enzyme inhibitors effects on,
guidelines for 247–248, 248f
CHEP 6, 561 dementia mechanisms in. See Dementia.
historical perspective of, 551–552 hypertension impact on. See Cerebrovascular disease;
international comparisons of, 571–575, 572t, 573t, Stroke entries.
575t Brain natriuretic peptide (BNP)
JNC 7, 553, 554t, 555 in heart failure diagnosis, 342
in adolescents, 441 inhibitors of, for hypertension, 298, 299f
in children, 441, 558 mediating role of, 41–42, 41f
at home, 76 Braking phenomenon
technical problems of, 144 loop diuretics and, 213–214
in chronic disease management, 532–533 pathophysiology of, 216
in elderly patients, 458 Breast milk, antihypertensive drugs and, 437–438
in home, 69–82. See also Home blood pressure Breathing patterns, sleep physiology and, 134
monitoring (HBPM). apneic, 134–141. See also Sleep apnea.
in hypertensive emergencies, 518, 519 restarting of, 136, 137, 137f
in new drug development, 543 British Hypertension Society
in office, 58–66. See also Office measurement of diuretic recommendations, 270
blood pressure. guidelines of, European and American guidelines vs.,
in perioperative hypertension, 514–515, 515f 575, 575t
obesity and home monitoring device recommendations, 70, 70t
problems with, 144, 370 British Regional Heart Study, 59, 59f
weight loss effect on, 372–378, 373t, 374f–376f, Bromocriptine
377t for hypertension, 296
resistant hypertension and, 499 hypertension related to, 147
technical problems of, 144, 172 Bronchopulmonary dysplasia, in infants, 446
BMI. See Body mass index (BMI). Bronchospastic disease, β-blocker cautions with, 231,
BNP. See Brain natriuretic peptide (BNP). 236
Board Certified Pharmacotherapy Specialists, 529 Buerger’s disease, 385
Body builders, hypertension in, 446 Bumetanide
resistant, 507, 508t adaptation to, 216
Body fat for resistant hypertension, 504
in obesity for transplant hypertension, 365t, 366
assessment of, 370, 371t pharmacokinetics of, 214–215, 214t
distribution of Bureau of Standards, of U.S. Department of Commerce,
calculation of, 370, 371t 551
resistant hypertension and, 509 Burns, hypertension related to, 446t
insulin resistance associated with, 418–419 Buspirone, hypertension related to, 146
storage of, in diabetes mellitus, 409, 409f
Body height. See Height percentiles.
Body mass index (BMI)
as risk factor, 5–6, 566 C-reactive protein
CHEP 7 guidelines for, 564 β-adrenergic blockers effects on, 234
coronary heart disease and, 194, 406 in metabolic syndrome, therapy indications based
in African Americans, 469, 470 on, 422, 422t
in East Asians, 488 in peripheral artery disease, 389
in obesity C-type natriuretic peptide (CNP)
calculation of, 370, 371t inhibitors of, for hypertension, 298, 299f
classification based on, 370, 371t mediating role of, 41–42, 41f
surgery and, 378 Ca -activated K+ channel (BKCa2+), vascular relaxation
2+

320f in obesity definition, 201, 418 and, 33, 34f

comparisons of different active regimens, 318, 321f,
322
data collection for, 317
diabetes findings of, 323
eligible trials for, 317
main findings of, 318, 319t
outcome specification for, 317
prespecified methods for, 317–318
statistical analysis for, 318
subgroup comparisons in, 317–318
trials and participants in second-cycle overviews, 318
trials of angiotensin receptor blockers, 322, 322f
in resistant hypertension, 500f, 508–509
obstructive sleep apnea syndrome and, 135, 137f
preeclampsia and, 435
Body weight. See Weight entries.
Bone marrow transplantation, hypertension related to,
361
drug therapy associations, 146
Bopindolol, 298
Bosentan, 296
angiotensin-converting enzyme inhibitors combined
with, 296–297
BP. See Blood pressure (BP).
Cabergoline, 296
CAD (coronary artery disease). See Coronary heart
disease (CHD).
CADASIL (cerebral autosomal dominant arteriopathy
with subcortical infarcts and
leukoencephalopathy), 401
Cadmium, hypertension related to, 147–148
Caffeine
home blood pressure monitoring and, 73, 73t
hypertension related to, 146
CAH (cyclosporine-associated hypertension), 146
Calcification, of arteries, in elderly, 144, 171, 458
584 Index
Calcineurin inhibitors (CNI), transplant hypertension
and, 361–363, 364–366
Calcitonin gene–related peptide (CGRP), mediating
role of, 26f, 43
Calcium
excretion of, diuretic therapy impact on, 213
in heart failure physiology, 340–341, 413
low serum, resistant hypertension related to, 500f,
501t, 504
Calcium antagonists. See Calcium channel blockers
(CCBs).
Calcium channel blockers (CCBs), 268–282
adverse effects of, 273, 274t, 275, 275f
ancillary properties of, 277–280
antiatherogenic action, 278–279, 278f, 278t
cognitive effects, 280
endothelium and, 279
large arteries and, 279–280
left ventricular hypertrophy regression, 279
renal effects, 277, 277f
bleeding associated with, 275
cancer associated with, 275
cardiovascular system physiology of, 268
selectivity in, 269, 269f, 270t
classification of, 268–269, 270t
contraindications for, 282t
chronic kidney disease as, 281
diabetes mellitus as, 280–281
diabetic nephropathy as, 280–281
pregnancy as, 281
dementia and, 184
diabetes onset associated with, 275–276
for angina, 281
stable, 335
for arterial stiffness, 36–37
for chronic kidney disease related hypertension,
357–358, 357t
for coronary artery disease, 329–330, 331t
for cyclosporine-associated hypertension, 146
for diabetes-related hypertension, 280–281, 410f,
411t, 412
type 2 diabetes pathology and, 414
for heart failure, 281, 341, 343
for hypertension, 269–277
β-adrenergic blockers vs., 270, 271, 273f, 276–277
angiotensin-converting enzyme inhibitors vs., 242,
243, 270, 271, 273f, 276–277
angiotensin II receptor blockers combined with,
258, 259–260, 263
blood pressure-lowering effects, 269–270
CHEP 6 guidelines for, 562t, 564t, 565, 565f
clinical outcome studies of, 271–273
meta-analysis of, 271–273, 273f
observational, 271
randomized controlled, 271, 272t
combination therapy with, 276–277, 276t
diuretic therapy vs., 217, 219
hemodynamic effects, 269–270
in African Americans, 270, 468, 475, 496
in children and adolescents, 450, 452t
in East Asian populations, 489, 490
in elderly patients, 459, 460, 461, 461t, 463, 463t,
464
in Hispanics, 484–485
in obesity, 378, 379, 380t
JNC 7 guidelines for, 556–557, 556t, 557f
safety of, 273, 274t, 275–276, 275f
WGTF 4 guidelines for, 560
for hypertensive emergencies, 518
for isolated systolic hypertension, 174, 281
for peripheral arterial disease, 389–390
for pregnancy-related hypertension, 281, 433–434,
433t
for primary aldosteronism, 115
for renovascular hypertension, 102
for resistant hypertension, 501t, 502, 503, 507–509
in multidrug program, 505–506, 505f
for ST-segment elevation myocardial infarction, 337
for stroke prevention
primary, 395, 396–397, 396f, 397f
secondary, 398
for transplant hypertension, 364, 365t
for vascular dementia, 402
guidelines for, international comparisons of, 574,
575, 575f
Calcium channel blockers (CCBs) (Continued)
historical studies on, 306
lipid-lowering drug interactions with, 420, 420t
mechanism of action, 268, 269f
meta-analyses of, 318, 319t, 320f–321f, 322, 323f
metabolic effects of, 275
outcome studies on, 308–309, 309f, 312
peripheral vascular resistance normalization by, 33
pharmacogenetic studies of, 20
pharmacology of, 268–269
preoperative, for pheochromocytoma resection,
127–128
special indications for, 281, 282t
vasodilators vs., 270
Calcium channels, voltage-gated, 268
α1-adrenoceptor activation and, 287, 287f
α1-subunits of, 268, 269f
L-type subunits of, 268, 269f
Calcium intake
dietary
blood pressure response to, 6, 206
targets for, 372, 373t
supplemental, for preeclampsia, 432
Calcium pump
adenosine triphosphate (ATP)-dependent, 268, 269f
receptor-operated, 268, 269f
Calibration, of manometers
ambulatory, 90–91
importance of, 144, 558, 561
in home, 70, 71f
in office, 60–61, 60f
CALM (Candesartan and Lisinopril Microalbuminuria)
study, 258, 412
Calorie intake, for weight loss, 372, 373t, 377t
CAM (complementary and alternative medicine),
ethnic use of, 485, 489
Cambridge rule, 506
CAMELOT (Comparison of Amlodipine versus
Enalapril to Limit Occurrences of
Thrombosis), 272t, 273, 279, 281
Canadian Coalition for High Blood Pressure Prevention
and Control (CCHBPPC), 552
Canadian Heart Health Survey (CHHS), 566–567
Canadian Hypertension Education Program (CHEP)
guideline initiative of 2005, 553, 553t
for adults, 561–565, 562t–564t, 565f
history of, 552–553
Canadian Hypertension Society (CHS), 55, 552
Cancer. See Carcinoma.
Cancer survivors, pediatric, angiotensin-converting
enzyme inhibitors effects on, 243
Candesartan and Lisinopril Microalbuminuria (CALM)
study, 258, 412
Candesartan cilexetil
efficacy of, 257, 344
for acute stroke, 399
for diabetes-related hypertension, 411t, 412
for obesity-related hypertension, 379
for transplant hypertension, 365t, 366
pharmacologic properties of, 255t, 256
Candesartan in Heart Failure Assessment of Reduction in
Mortality and Morbidity (CHARM), 244, 344
diabetic patients in, 411t, 414
outcome-based results of, 258, 259f, 261–262, 264
Candidate genes
antihypertensive drug treatment and, 20–21
association studies of, 18–20, 19t
pathophysiologic mechanisms of, 26–28
risk related to, 6
vascular tone experiments in, 34
Cannabinoid receptor antagonists, new investigations
on, 300
Canrenonate potassium, for hypertension, 295
Canrenone, for hypertension, 295
CAPPP. See Captopril Prevention Project (CAPPP).
Captopril, 240t, 249
breast milk concentrations of, 437
clinical trials on, 245, 246, 247, 353t
for children and adolescents, 450, 451t
for diabetes-related hypertension, 410, 411t
for East Asian populations, 489
for perioperative hypertension, 514
for peripheral arterial disease, 390
for ST-segment elevation myocardial infarction, 337
for transplant hypertension, 365t, 366
Captopril (Continued)
pharmacology of, 239
regulatory development of, 542, 545
Captopril in Diabetic Nephropathy Trial, 357
Captopril Prevention Project (CAPPP), 220f–221f, 244,
319t
diabetic patients in, 410, 411t, 414
outcome design of, 308–309, 309f
Captopril renogram
for renovascular hypertension, 95–96, 97f
for resistant hypertension, 502
performance characteristics of, 97t, 98–99
Carbohydrate intake, for weight loss, 372, 373t
Carbohydrate intolerance, diuretic-induced, 226
Carbonic anhydrase inhibitors, 213
adverse effects of, 225, 227
nephron sites of action, 213, 214f
pharmacokinetics of, 213, 214t
Carcinogenesis, diuretics and, 227
Carcinoid syndrome, resistant hypertension related to,
500f, 504
Carcinoma(s)
calcium channel blockers associated with, 275
medullary thyroid, secondary hypertension related
to, 119, 120, 121
pediatric survivors of, angiotensin-converting
enzyme inhibitors effects on, 243
post-heart transplant risks of, 348
renal cell, diuretic-associated, 227
small cell lung, 148
CARDIA (Coronary Artery Risk Development in Young
Adults) study, 6, 29, 470
Cardiac action potential, β-adrenergic blockers effect
on, 231, 232t
Cardiac allograft vasculopathy (CAV), 348
Cardiac anomalies, congenital, hypertension related to,
446
Cardiac arrest, thiazide diuretics causing, 224, 225f
Cardiac arrhythmias. See Dysrhythmias.
Cardiac embolic infarction, 183
Cardiac load, in left ventricular hypertrophy, 179
Cardiac output (CO)
acromegaly impact on, 150
arterial blood pressure regulation by, 286
blood pressure measurement and, 64
diuretics effect on, 217, 217f
heart transplant and, 347
in isolated systolic hypertension, 171, 173
preeclampsia and, 436
sleep apnea impact on, 136–138, 137f–138f
prognostic consequences of, 139, 139f
transplant hypertension and, 361, 362
Cardiac pacing, heart failure indications for, 344–345
Cardiac Transplant Research Database, 348
Cardiometabolic syndrome, hypertension in, 406, 407t,
409. See also Metabolic syndrome.
Cardiomyopathy
diabetic, 413
dilated, electrical therapy for, 344–345
Cardiovascular and Renal Drugs Advisory Committee,
538, 544, 546
Cardiovascular death
albuminuria risk factor for, 355, 355f
diuretics effect on, 218–219, 220f–221f
guidelines for, international comparisons of, 571, 572f
in Hispanics, 483
in resistant hypertension, 498
in South Asians, 493, 494t, 496
in untreated hypertension, 155–157
meta-analyses of, 317, 319t
active regimens and controls, 318, 320f
angiotensin receptor blockers, 322, 322f
blood pressure and risk, 323, 323f
different active regimens, 318, 321f
meta-analysis of, 161–162, 162f
outcome studies on, 310–311, 310f
perioperative hypertension and, 512–513, 513t
sleep apnea and, 139, 139f
stroke association with, 395, 395f
Cardiovascular disease (CVD)
α-adrenergic blockers effects on, 289–291, 290f
β-adrenergic blockers effects on, 234, 236
angiotensin-converting enzyme inhibitors for, 239,
240, 240t, 242, 243
end-organ effects and, 246–247

Cardiovascular disease (Continued)
blood pressure monitoring prediction of
ambulatory, 86, 87f
in elderly patients, 457–458
in home, 77
calcium channel blockers effect on, 278–279
chronotherapy for
assessing effects of, 89–90, 90t
delivery systems impact on, 90
circadian patterns of, 89
diabetes mellitus risks for
target organ damage and, 409, 413
type 1, 406, 407, 407t
type 2, 407, 408f
diet and, 201, 202f, 203, 208
diuretics for
adverse effects implications of, 223–224, 225f
clinical trials on, 218–219, 220f–221f
end-stage, 213, 214t, 216
historical studies on, 305, 306
hypertension risk for. See Cardiovascular risk.
hypertensive, 3, 58
in chronic kidney disease, treatment goals for, 356–357
in East Asians, 487, 489, 490
in elderly patients
epidemiology of, 457–458
pharmacologic treatment benefits for, 459–460, 459t
in Hispanics, 483, 485
in South Asians, 493, 494t, 496
in untreated hypertension, 157–159, 161–163, 164
meta-analyses of, 317, 319t
active regimens and controls, 318, 320f
angiotensin receptor blockers, 322, 322f
blood pressure and risk, 323, 323f
different active regimens, 318, 321f
mortality outcome of. See Cardiovascular death.
obstructive sleep apnea syndrome and, 138, 138f
CPAP application impact on, 140
mortality associations, 139, 139f
peripheral artery disease associated with, 384, 385
pheochromocytoma vs., 119, 120t
pulse pressure as marker for
blood pressure assessment in, 171, 171f
diagnostic caveats in, 172–173
meta-analysis of, 169–170, 170f
redefining hypertension for, 54, 55
renovascular hypertension and, 94
subclinical, 195
target organ damage assessment in, 178–181, 179t
white-coat hypertension risk for, 87
Cardiovascular events. See Cardiovascular disease (CVD).
Cardiovascular Health Study (CHS)
African Americans in, 469
of older U.S. residents, 8–9, 9t, 341
peripheral arterial disease in, 386
renovascular hypertension in, 94
Cardiovascular Outcomes in Renal Atherosclerotic
Lesions (CORAL) study, 502
Cardiovascular risk
diabetes mellitus and
target organ damage with, 409, 413
type 1, 406, 407, 407t
type 2, 407, 408f
in hypertension
antihypertensive drug therapy goals and, 51–52
atherothrombotic events with, 6
caveats in diagnosing, 172–173
cross-classification of risk groups, 12, 12f
definition approach based on, 50–51, 51f–52f
diuretics effect on, 217, 218–219, 220f–221f
epidemiology studies of, 3, 5
genetics of, 26f, 27, 28
global, 190–196
definition of, 423
dyslipidemia and, 190, 191f, 196, 418
therapy indications based on, 422, 422t
epidemiology of, 4–5
European approach to, 193
in African-American population, 195–196
international comparisons of, 573
lifestyle and, 193–194
multivariate risk estimation, 192–193, 192f–193f
newer issues for, 194–195, 194f
traditional factors of, 190–192, 191f
historical perspective of, 58
Cardiovascular risk (Continued)
in older individuals, 12–13, 13t
in transplant recipients, 361, 367
inherited factors of, 29
outcome studies on, 307–308, 308f, 311
outcomes with, 7–8, 8f, 11, 11f, 29
pulse pressure and, 8, 9t, 11–12
staging systems and, 6
systolic blood pressure importance, 8–10, 9t
untreated, 157–159, 158f–159f
in resistant hypertension, 498
meta-analyses of, 317, 319t
active regimens and controls, 318, 320f
angiotensin receptor blockers, 322, 322f
blood pressure and risk, 323, 323f
different active regimens, 318, 321f
perioperative hypertension and
antihypertensive medication effects on, 513–514
clinical predictors of, 512–513, 513t
management algorithm for, 514–515, 515f
total, international comparisons of, 573
treatment guidelines for, 566
CHEP 6, 561, 562t–563t
international comparisons of, 571, 572, 572f, 573
JNC 7, 553, 555
WGTF 4, 560, 561
vascular dementia associated with, 401
Cardiovascular system
angiotensin-converting enzyme inhibitors effects on,
241, 241t
atrial natriuretic peptide in
expression of, 42, 42f
mediating role of, 26f, 41–42, 41f
calcium channel blockers physiology in, 268
selectivity of, 269, 269f, 270t
new drug development and, 540
preeclampsia and, 436
sleep physiology and, 134, 136t
sympathetic nervous system regulation of, 29–30, 31f
Carmoxirole, 296
Carney triad/syndrome, secondary hypertension related
to, 120, 121t, 122
Carotid arteries
assessment of, 182
atheroma of, stroke related to, 394
revascularization of, for stroke prevention, 400–401,
400t
stenosis of, in untreated hypertension, 156f, 165
Carotid endarterectomy, for stroke prevention, 400–401,
400t
Carotid-femoral pulse wave velocity, 182
Carotid intima-media thickness
in children and adolescents, 447
in untreated hypertension, 156f, 165
Carotid sinus, mechanoreceptors in, 29, 30f, 31f
Carotid sinus massage, post-heart transplant, 347
Carotid tonometry, for arterial assessment, 182
Carteolol
elimination characteristics of, 234t
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
Carvedilol, 236
α1-adrenoceptor antagonist activity of, 288
elimination characteristics of, 234t
for diabetes-related hypertension, 413
for heart failure, 344
for resistant hypertension, 505f, 506
molecular structure of, 232, 235f
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
Case-control studies, of genetics, 17, 18–20, 19t
Case finding, for pheochromocytoma diagnosis,
122–124, 124f
Case management, nurse
for chronic conditions, 527–528
of hypertension, 528–529
Catalytic actions, of angiotensin converting enzymes,
37–38, 37f
Catecholamine crisis, hypertensive emergency with, 522
Catecholamine-secreting paragangliomas, extra-adrenal,
119
Catecholamine-secreting tumors, 119. See also
Pheochromocytoma.
Catecholamine synthesis inhibitor, preoperative, for
pheochromocytoma resection, 127
Index 585
Catecholamines
transplant hypertension and, 347, 362
urine vs. plasma studies of, for pheochromocytoma,
119, 121f, 122, 123
postoperative follow-up, 128–129
Cathepsin, 37
CAV (cardiac allograft vasculopathy), 348
CCBs. See Calcium channel blockers (CCBs).
CCHBPPC (Canadian Coalition for High Blood
Pressure Prevention and Control), 552
CCM (chronic care model), for disease management,
528, 531, 532f
CDC (Centers for Disease Control), Pediatric Nutrition
Surveillance System, 472
CDER (Center for Drug Evaluation and Research), 537
Celiprolol, 298
elimination characteristics of, 234t
pharmacokinetic properties of, 232–233, 233t
Cellular rejection, acute, in heart transplant, 347
Center for Drug Evaluation and Research (CDER), 537
Center for Medicare & Medicaid Services (CMS), 531
Centers for Disease Control (CDC), Pediatric Nutrition
Surveillance System, 472
Central Americans. See Hispanics.
Central arteries, large, 181, 182
assessment of, 181, 182
Central nervous system (CNS)
angiotensin-converting enzyme inhibitors effects on,
241–242
stroke and, 247–248, 248f
β-adrenergic blockers effect on, 236
preeclampsia and, 436
sleep disturbance impact on, 135, 136t, 137,
137f–138f, 139
CPAP application and, 140
tumors of, resistant hypertension related to, 500f,
504
Central obesity, 370
in African Americans, 472, 473f
Central sleep apnea syndrome (CSAS), 134, 135t
Cerebral angiography, for stroke assessment, 184
Cerebral arteries
large, infarction of, 183
occlusion of, 392, 393f
perfusion of, autoregulation of, 399
stroke pathology of. See Stroke/stroke mortality.
Cerebral autosomal dominant arteriopathy with
subcortical infarcts and leukoencephalopathy
(CADASIL), 401
Cerebral function/dysfunction, pulsatile stress and,
170
Cerebral infarction, 183
hypertensive emergency with, 517, 518, 518t, 519
management of, 521
Cerebroprotective effect, of angiotensin-converting
enzyme inhibitors, 248, 248f
Cerebrovascular disease, in hypertension, 392–402
angiotensin II receptor blockers for, 259f, 263
assessment of, 183–184
dementia with, 184
demographics of, 183
diuretics for, 217
clinical trials on, 218–219, 220f–221f
encephalopathy with, 184
in East Asians, 489, 490
in Hispanics, 483
pathogenesis of, 183
stroke as, 392–401. See also Stroke/stroke mortality.
syndromes with, 183–184
vascular dementia as, 401–402
blood pressure as risk for, 164, 401
blood pressure-lowering treatment for, 401–402,
402f
neuroimaging of, 401
prevalence of, 401
prevention of, 401–402
term descriptions for, 401
with pregnancy-related hypertension, 431, 432, 437
Certification programs, for blood pressure
measurement
historical perspective of, 58
standardized monitoring of, 64–66, 65f
CGRP (calcitonin gene–related peptide), mediating role
of, 26f, 43
Characteristic aortic impedance (Zc), 182
586 Index
CHARM. See Candesartan in Heart Failure Assessment
of Reduction in Mortality and Morbidity
(CHARM).
CHD. See Coronary heart disease (CHD).
Chemoreceptors
exaggerated function of, 32
in kidneys, 30, 30f–32f
obstructive sleep apnea syndrome and, 136–137,
137f–138f
Chemoreflex pathways, 29, 31f
Chemotherapy, combination, for metastatic
pheochromocytoma, 129–130
CHEP. See Canadian Hypertension Education Program
(CHEP).
Chest radiography
for children and adolescents, 448
for heart failure assessment, 179t, 181
aging impact on, 341
for hypertensive emergencies, 518
Cheyne-Stokes breathing pattern, 134, 135t
CHF. See Heart failure (HF).
CHHIPS (Control of Hypertension and Hypotension
Immediately Post-stroke), 399
CHHS (Canadian Heart Health Survey), 566–567
Chicago Western Electric Study, 206
Childbirth
premature
in African Americans, 472
pregnancy-related hypertension and, 431
timing of, in preeclampsia, 436
Children
as cancer survivors, angiotensin-converting enzyme
inhibitors effects on, 243
blood pressure measurement in, 441, 558
in home, 76
technical problems of, 144
hypertension in, 440–454
by age percentiles, 440, 442t, 444t
by height percentiles, 440, 442t, 444t
by sex, 440, 442t, 444t
defining, 49–50, 50f, 54, 440
diet and, 207–208
therapeutic changes in, 449–450, 449f
essential, 446–447
characteristic findings of, 448
evaluation of, 447–449, 449f
diagnostic testing for, 448–449
medical history in, 447–448
physical examination in, 447–448
lifestyle changes for, 449, 449f
new drug development and, 546
obesity trends and, 6, 207–208, 447
weight loss for, 449
obstructive sleep apnea syndrome and, 135, 139
pharmacotherapy for, 449f, 450
for emergencies and urgencies, 454t
outpatient, 451t–453t
WGTF 4 guidelines on, 559t, 560–561, 560f
practice standards for, 552, 553t
prevalence of, 440
risk factors for, 6, 440
secondary causes of, 441, 446
acute vs. chronic, 446t
target organ damage with, 447, 448, 449f, 450
treatment of, 449–450
algorithm for, 449, 449f
behavioral changes as, 449–450
pharmacotherapy as, 450, 451t–454t
WGTF 4 clinical practice guidelines for, 558–561,
559t, 560f
prehypertension in, 440
Chimeric gene, in glucocorticoid-remediable
aldosteronism, 115, 116f
Chinese populations
hypertension in
prevalence of, 487, 488t
treatment of
considerations for, 488–489
outcome studies of, 487, 489–490
side effects with, 487, 490
stroke prevention trials in, 398, 398f
stroke risk in, 394, 395f
Chloride, reabsorption of, diuretic therapy impact on,
213, 214f, 215, 216
Chloride channel, mutations in, 27t
Chlorothiazide (CTZ), 214t, 227
Chlorthalidone, 218, 219, 227
calcium channel blockers vs., 272t
clinical outcome studies on, 307, 308, 308f, 311, 312
for diabetes-related hypertension, 411t, 412
for heart failure, 342, 343
for hypertension
doxazosin vs., 288, 290, 290f
in African Americans, 475
in children and adolescents, 450, 452t
in elderly patients, 459, 460
for stroke prevention, 397
for transplant hypertension, 365t, 366
historical studies on, 305, 306
regulatory development of, 542
Cholesterol intake
blood pressure response to, 206
for weight loss, 372, 373t
Cholesterol level
α-adrenergic blockers effects on, 291
atherogenic. See Dyslipidemia.
coronary artery disease risk with, 327, 328t
diuretics effect on, 226–227
elevated. See Hypercholesterolemia.
guidelines for, international comparisons of, 573
historical studies on, 305, 306
lowering therapies for. See Lipid-lowering therapies.
Choroidal vascular changes, in hypertensive
retinopathy, 184–185, 185t
Christian, Henry A., 156
Chromosomes
linkage studies on, 18, 20, 21f
mutations of
implications of, 23
Mendelian forms of, 27t
Chronic care model (CCM), for disease management,
528, 531, 532f
Chronic heart failure
angiotensin II receptor blockers for, 259f, 261–262
congestive. See Heart failure (HF).
Chronic hypertension
in children, secondary causes of, 441, 446, 446t
in pregnancy, 429–435
characteristics of, 429
differential diagnosis of, 429–431, 431f
fetal risks with, 431
management of, 431–435
nonpharmacologic, 432
pharmacologic, 432–435
preconception, 431–432
preeclampsia prevention, 432
maternal risks with, 431
pharmacologic management of, 432–435, 433t
α-adrenergic blockers in, 433
β-adrenergic blockers in, 234, 432–433
angiotensin-converting enzyme inhibitors in,
248–249, 431, 434–435
angiotensin II receptor blockers in, 431, 434
calcium channel blockers in, 281, 433–434
central adrenergic agonists in, 432
diuretics in, 434
FDA classification of, 432
initiation parameters for, 432
serotonin2-receptor blockers in, 434
vasodilators in, 434
sleep apnea mechanisms of, 137, 138f
Chronic illness(es)
case management for, 527–528
concomitant. See Comorbidities.
disease management model for, 528, 531, 532f
Chronic kidney disease (CKD), 351–358
angiotensin-converting enzyme inhibitors and,
244–246, 245f, 246t
angiotensin receptor blockers and, 257–260, 356–359
assessment of, 186–187
CHEP 6 guidelines for, 561, 564t, 565
diagnostic definition of, 186, 351
hypertension treatment with, 357–358, 357t
in African Americans, 469, 476–477
low birth weight risk for, 472
pressure-related mechanisms of, 472–474, 473f
JNC 7 guidelines on, 555, 556t
long-term outcome studies on, 353–354, 353t
pathophysiology of, 185–186, 351–352, 352t
prevalence of, 185, 351, 352f, 352t
Chronic kidney disease (CKD) (Continued)
progression and staging of, 186, 186t
based on glomerular filtration rate, 351, 352t
treatment of
angiotensin-converting enzyme inhibitors, 353,
353t, 354, 355–356
hypertension management and, 357–358, 357t
angiotensin II receptor blockers in, 356, 357–358,
357t
blood pressure targets, 352–354, 353f–354f
calcium channel blockers in, 281, 357–358, 357t
cardiovascular disease targets, 356–357
clinical trial on, 353–354, 353t
diuretic therapy impact on, 213, 215, 216
for hypertension, 357–358, 357t
goals for, 352–357
microalbuminuria targets, 354–355, 355t, 356
potassium intake restriction for, 204
proteinuria targets, 355–356, 355t
WGTF 4 guidelines for, 558, 560
Chronic obstructive pulmonary disease, β-adrenergic
blockers use with, 236
Chronic-phase response, to diuretics, 218
Chronotherapeutic agents, ambulatory blood pressure
monitoring for
assessing effects of, 89–90, 90t
delivery systems impact on, 90
Chronotherapeutic oral drug absorption system
(CODAS) delivery system, 90
Chronotropy, sympathetic nervous system activity
and, 29
CHS. See Cardiovascular Health Study (CHS).
CHS (Canadian Hypertension Society), 55, 552
Chymase, 39
CI (confidence interval), in outcome studies, 307–308,
311
Cigarette smoking
as renovascular hypertension risk, 95, 96t, 102
cessation programs for, 422, 423, 532
coronary artery disease risk with, 327, 328t
global cardiovascular risk and, 191, 423, 566
home blood pressure monitoring and, 73, 73t
obstructive sleep apnea syndrome and, 136, 136t
peripheral artery disease associated with, 384, 385,
388
resistant hypertension related to, 508, 508t
Circadian pattern
in renin-angiotensin-aldosterone system, 89
of blood pressure, 85–86, 86f
acromegaly impact on, 150
transplant hypertension and, 362–363, 363f
of cardiovascular diseases, 89, 90
Cisapride, 539
CKD. See Chronic kidney disease (CKD).
Class effect
of angiotensin-converting enzyme inhibitors, 240–241
of diuretics, 218
CLCNKB gene, 27t
Clinic monitoring of blood pressure, 58–66. See also
Office measurement of blood pressure.
Clinical drug development. See also Investigational new
drugs (INDs).
regulatory perspectives of, 535–546. See also
Regulatory development.
Clinical efficacy, in new drug development, 535,
540–543, 541f
Clinical endpoints
composite, unbiased assessment of, 310–311, 310f
defining, 310–311
randomized trials with. See Outcome study(ies).
regulatory perspectives of, 537, 543, 546
surrogate endpoint vs., 535
Clinical practice
antihypertensives in. See Antihypertensive drug
therapy.
guidelines for. See Clinical practice guidelines
(CPGs).
models of, traditional vs. virtual hypertension clinic,
81–82, 81f
Clinical practice guidelines (CPGs)
British, 575, 575t
Canadian
CHEP 6, for adults, 561, 562t–564t, 564–565, 565f
historical perspective of, 552–553
discussions relating to, 566

Clinical practice guidelines (CPGs) (Continued)
effectiveness of, 566–567
European. See European Society of Hypertension.
evidence-based, 551, 552
federal sources of, 552, 552t–553t
for children, 558, 559t, 560–561, 560f
future directions for, 567
goal of, 551, 566–567
institutional sources of, 553, 553t
international comparisons of, 571–575, 572t, 573t, 575t
JNC 7, 553–557, 554t, 556t, 557f
practitioners adherence to, 527, 532f, 567
professional sources of, 552, 552t. See also specific
association or society, e.g., American Heart
Association (AHA).
United States, 551–561. See also United States
guidelines.
Web-based database of, 552
Clinical prediction rule, for renovascular hypertension
risk, 95, 96t
Clinical trials
blood pressure measurement for
ambulatory
chronotherapeutic agents assessment, 89–90, 90t
chronotherapeutic agents delivery systems
and, 90
data analyses of, 88–89, 89t
different drug class comparisons, 89
same drug class comparisons, 89
in home, 80–81
of time course, 80
of trough-to-peak ratio, 72, 80
placebo effect immunity, 80, 80t
sample size advantage, 81
target organ damage correlation, 76–77, 80
in office, 58, 74
“J-curve” phenomenon in, 55
targets based on, 55
WHO data summary of, 52
cardiovascular death in, 161–162, 162f
disease management trends, 527
heart failure in, 162–163
ischemic heart disease in, 157–159, 159f, 159t
meta-analyses of, 316–323. See also Meta-analyses.
on renovascular hypertension management, 102–103
angioplasty vs. medical management, 102–103
surgery vs. angioplasty, 102
surgery vs. medical management, 102
other cardiovascular endpoints in, 164
phases of, 537–538
public perception of, 313
randomized, with clinical endpoints. See Outcome
study(ies).
registration with National Institutes of Health, 312
regulatory perspectives of, 535–546. See also
Regulatory development.
renal failure in, 163–164, 163f
results of. See specific agent, drug classification or trial.
stroke in, 159–161, 160f–161f
Clinics
pharmacist-managed, for disease management, 530
university-based, 530
resistant hypertension associated with, 504, 504t,
506
Clonidine
for diabetes-related hypertension, 413
for hypertension, 297, 297f, 298t
in African Americans, 475, 476
in children and adolescents, 450, 452t, 454t
for pregnancy-related hypertension, 433t, 434
for resistant hypertension, 505f, 506
naloxone reversal of, 145
Clonidine suppression test, for pheochromocytoma, 123
Clopidogrel
for angina, unstable, 336
for stroke prevention, 399
Clothing, removal of, for blood pressure measurement, 63
Clozapine, hypertension related to, 146
Clumsy hand syndrome, dysarthria and, 183
CMS (Center for Medicare & Medicaid Services), 531
CNI (calcineurin inhibitors), transplant hypertension
and, 361–363, 364–366
CNP (C-type natriuretic peptide)
inhibitors of, for hypertension, 298, 299f
mediating role of, 41–42, 41f
CNS. See Central nervous system (CNS).
CO. See Cardiac output (CO).
Coagulopathy
in metabolic syndrome, therapy indications based
on, 422, 422t
in preeclampsia, 429, 435
Coarctation of the aorta
hypertension related to, 148, 446, 448
resistant hypertension and, 500f
Cocaine intoxication, hypertension related to, 145
CODAS (chronotherapeutic oral drug absorption
system) delivery system, 90
Codergocrine, 296
COER (controlled-onset extended-release) delivery
system, for chronotherapy, 90
Cognition, calcium channel blockers effect on, 280
Cognitive decline/impairment, 401–402
blood pressure and
as risk factor, 164, 401
treatment trials for lowering, 401–402, 402f
in elderly patients, 159f, 164, 184
pharmacotherapy effects on, 463–464, 463t
neuroimaging of, 401
prevalence of, 401
prevention of, 401–402
prodromal stage of, 401
Cognitive skills
angiotensin-converting enzyme inhibitors effects on,
247–248, 248f
for blood pressure measurement, 60, 60f
hypertension impact on, 159f, 164, 184. See also
Cognitive decline/impairment.
Cold pressor testing, 33
Collaboration models, of disease management
community pharmacy/pharmacists in, 529–530
integrated, 531–533, 532f
nurse-pharmacist, 530–531
pharmacist-managed clinics and, 530
physician-pharmacist, 530
Collagen, arterial stiffness related to, 36, 340
Collagen vascular disease, preeclampsia and, 431, 435
Collecting tubule, diuretics action in, 213, 214f, 214t
Combination therapy. See also specific agent or drug
classification.
CHEP 6 guidelines for, 562t–563t, 564–565, 565f
fixed, 544, 544f
for dyslipidemia, and hypertension, 424
for elderly patients, 463
international comparisons of, 573–574, 574f
regulatory development of, 543, 544, 544f
Combination Treatment of Angiotensin II Receptor
Blocker and Angiotensin-Converting Enzyme
Inhibitor in Nondiabetic Renal Disease
(COOPERATE) trial, 245, 353t, 356, 358
Common Technical Document (CTD), 538
“Community-based blood pressure monitoring,” 80
Community pharmacy/pharmacists, disease
management role, 529–530
Community programs, for hypertension treatment, 305
Comorbidities, of hypertension
cerebrovascular disease as, 392–402. See also
Cerebrovascular disease.
CHEP 6 guidelines for, 561, 562t–564t
diabetes mellitus and, 406–415. See also Diabetes
mellitus (DM).
dyslipidemia as, 418–424. See also Dyslipidemia.
heart disease as, 178, 179t. See also Cardiovascular
disease; Ischemic heart disease.
heart failure as, 340–348. See also Heart failure (HF).
in children, WGTF 4 guidelines for, 558, 560
in chronic disease management, 532–533
kidney disease as, 351–358. See also Kidney disease.
obesity as, 370–380. See also Obesity.
organ transplant and, 361–367. See also Transplant
hypertension.
peripheral arterial disease as, 384–390. See also
Peripheral arterial disease (PAD).
Comparison of Amlodipine versus Enalapril to Limit
Occurrences of Thrombosis (CAMELOT),
272t, 273, 279, 281
Compelling indications, for pharmacotherapy,
562t–563t, 564–565, 565f
CHEP 6 guidelines for, 562t–563t, 564–565
JNC 7 algorithm for, 557f
JNC 7 guidelines on, 555, 556–557, 556t
Index 587
Compelling indications, for pharmacotherapy
(Continued)
WGTF 4 algorithm for, 560f
WGTF 4 guidelines for, 558, 559t, 560–561
Competing exogenous substances, resistant
hypertension related to, 500f, 507–508, 508t
Complementary and alternative medicine (CAM),
ethnic use of, 485, 489
Compliance
by patient, to treatment. See Nonadherence.
of arteries, 327, 329f
Composite endpoints, in outcome studies, 310–311,
310f
Computational methods, for gene association studies, 29
Computed tomography angiography (CTA), for
renovascular hypertension, 95–97
performance characteristics of, 97t, 99–100
resistant, 501t, 502
Computed tomography (CT) scan
for adrenal adenoma localization, 113
for pheochromocytoma localization, 119, 121f, 122,
124f, 125
for stroke assessment, 184, 392
in left ventricular hypertrophy assessment, 179t, 180
Computer databases, of genetic studies, 16, 18
Computer technology, in virtual hypertension clinic,
81–82, 81f
Concentric left ventricular hypertrophy (LVH),
178–179, 179t, 180
Concomitant diseases. See Comorbidities.
Conduit arteries
muscular, 181, 182
stiffness and, 36. See also Arterial stiffness.
Confidence interval (CI), in outcome studies, 307–308,
311
Confounders, in outcome studies, 307
Congenital adrenal hyperplasia, hypertension related to,
106
Congenital anomalies, hypertension related to, 446, 558
Congestive heart failure (CHF). See Heart failure (HF)
Connective tissue disorders, peripheral artery disease
associated with, 385
CONSENSUS-1 (Cooperative North Scandinavian
Enalapril Survival Study), 343, 343f
Consent
for release of medical information, 529
informed, for clinical trials, 313
“Consumer Reports” analysis, of treatment, 311
Continue or Stop Post-stroke Antihypertensives
Collaborative Study (COSSACS), 399
Continuous positive airway pressure (CPAP), nasal, for
obstructive sleep apnea syndrome, 140, 140f, 141
Contraceptives, oral, hypertension related to, 145, 146
Control groups
for new drug development, 540–542, 541f
in outcome studies, 307–310, 308f
Control of Hypertension and Hypotension Immediately
Post-stroke (CHHIPS), 399
Controlled-onset extended-release (COER) delivery
system, for chronotherapy, 90
Controlled Onset Verapamil Investigation of
Cardiovascular End Points (CONVINCE) trial,
90, 308–310, 309f, 319t
calcium channel blockers in, 272t, 275, 276t
composite outcome assessment for, 310–311, 310f
Hispanics in, 484
resistant hypertension in, 498, 509
CONVINCE. See Controlled Onset Verapamil
Investigation of Cardiovascular End Points
(CONVINCE) trial.
Coope & Warrender study, 159f, 161f, 162f
COOPERATE (Combination Treatment of Angiotensin
II Receptor Blocker and Angiotensin-
Converting Enzyme Inhibitor in Nondiabetic
Renal Disease) trial, 245, 353t, 356, 358
Cooperative North Scandinavian Enalapril Survival
Study (CONSENSUS-1), 343, 343f
Coordination skills, for blood pressure measurement,
60, 60f
Coping strategies, in African Americans, 470
CORAL (Cardiovascular Outcomes in Renal
Atherosclerotic Lesions) study, 502
Cornell voltage-duration product, 179, 179t, 180
as criterion for left ventricular hypertrophy, 179t,
180, 341
588 Index
Coronary angiography
for angina assessment, 335
for ischemic heart disease assessment, 180
Coronary arteries. See Coronary blood flow.
Coronary artery bypass graft
for angina, unstable, 336
for left ventricle restoration, 346
Coronary artery disease (CAD). See Coronary heart
disease (CHD).
Coronary Artery Risk Development in Young Adults
(CARDIA) study, 6, 29, 470
Coronary blood flow
heart failure impact on, 341
perfusion pressure for, 333–334, 333f
A Coronary Disease Trial Investigating Outcome with
Nifedipine Gastrointestinal Therapeutic System
(ACTION), 272t, 273, 281
Coronary heart disease (CHD)
angiotensin-converting enzyme inhibitors for, 242,
243
end-organ effects and, 247
blood pressure lowering parameters for, 333–334
chronic kidney disease and, 185
diuretics effect on, 218–219, 220f–221f
dyslipidemia and
as risk factor, 327, 328t, 418
predictors of, 419
treatment indications for, 418, 419t, 420, 422,
423
Framingham Heart Study findings, 327, 328t, 330f
global prediction of, 190–196
European approach to, 193
in African-American population, 195–196
lifestyle and, 193–194
multivariable risk estimation, 192–193, 192f,
194–195, 194f
newer factors in, 194–195, 194f
traditional risk factors in, 190–192, 191f, 419
heart failure and, 341
historical studies on, 305–306
hypertension risk for, 7, 8f, 327–328, 328f
diagnostic caveats in, 55, 172–173
management of, 334–335
predictive data on, 190–196
primary prevention of, 328–334
untreated, 157–159, 158f–159f
in elderly patients, 458, 459, 459t
in South Asians, 493, 494t
inflammation and, 194
JNC 7 guidelines on, 555, 556t
kidney disease and, 195
lifestyle and, 193–194
lifetime risk of, 194
lipid biomarkers of, 7, 8f, 12, 190, 191f
newer, 195
meta-analyses of, 317, 319t
active regimens and controls, 318, 320f
angiotensin receptor blockers, 322, 322f
blood pressure and risk, 323, 323f
different active regimens, 318, 321f
metabolic syndrome and, 195, 327
mortality with, 9, 9f
in older individuals, 13, 13t
trends with untreated hypertension, 155, 156
multivariable risk estimation for, 192–193, 192f
newer issues for, 194–195, 194f
outcome studies on, 307–308, 308f
perioperative hypertension related to, 512, 513t, 514
management of, 514–515, 515f
peripheral artery disease associated with, 384, 385
pulse pressure and
blood pressure assessment in, 171, 171f, 328, 330f
meta-analysis of, 169–170, 170f
redefining hypertension for, 55
relative risk for, 9, 11, 11f
risk factors for, 327, 328t
dyslipidemia as, 327, 328t, 418
stroke association with, 395, 395f
subclinical, 195
Coronary syndromes, acute, hypertension management
with, 336–337
Corticosteroids
elderly patients use of, 458
for organ transplantation, hypertension related to,
361, 362
Corticosterone, hypertensive syndromes related to, 107,
107t
Corticotropin. See also Adrenocorticotropic hormone
(ACTH).
hypertensive syndromes related to, 106–108
in Cushing’s syndrome, 148–149
pheochromocytoma-related secretion of, 119
Corticotropin-releasing hormone test, for Cushing’s
syndrome, 149
Cortisol, oral, hypertension related to, 145
Cortisol production, hypertensive syndromes related to
Cushing’s syndrome and, 109–110, 148–149
deoxycorticosterone and, 106, 107
mineralocorticoid receptors and, 108–109, 109f
Cortisol ratio, adrenal vein-to-peripheral vein, for
adrenal adenoma localization, 113
COSSACS (Continue or Stop Post-stroke
Antihypertensives Collaborative Study), 399
Cost-effectiveness
of disease management programs, 532
of home blood pressure monitoring, 81, 81t
“Cotton-wool spots,” in hypertensive retinopathy, 184
Cough/coughing
angiotensin-converting enzyme inhibitor-induced,
249
angiotensin II receptor blockers causing, 264
Cough medications, hypertension related to, 146
Council on Epidemiology (AHA), Pooling Project of, 155
Counseling
nutrition, 375
for peripheral artery disease, 388, 389
on future pregnancy, 437
postpartum, on preeclampsia, 437–438, 438f
COX-2 (cyclooxygenase-2) inhibitors
angiotensin-converting enzyme inhibitors and, 241
resistant hypertension related to, 508, 508t
CPAP (continuous positive airway pressure), nasal, for
obstructive sleep apnea syndrome, 140, 140f, 141
CPGs. See Clinical practice guidelines (CPGs).
CPI (cross-power index), in sleep disorders, 134
Creatinine
angiotensin-converting enzyme inhibitors and, 246
in end-stage renal disease, 163–164, 163f, 358
serum
as post-transplant marker, 364, 366
in chronic kidney disease, 186, 186t, 187, 351, 352,
355t, 356, 358
in preeclampsia, 431, 435, 436
in resistant hypertension, 500, 501t, 502
Creatinine-to-albumin ratio, in chronic kidney disease,
354–355, 355t, 356
Cromakalim, 299
Cross-power index (CPI), in sleep disorders, 134
CS (captopril scintigraphy), for renovascular
hypertension, 95–96, 97f
performance characteristics of, 97t, 98–99
CSAS (central sleep apnea syndrome), 134, 135t
CT scan. See Computed tomography (CT) scan.
CTA. See Computed tomography angiography (CTA).
CTD (Common Technical Document), 538
CTZ (chlorothiazide), 214t, 227
Cubans. See Hispanics.
Cuff bladder, blood pressure
accurate application of, 62–63, 62f
measurements of
arm circumference vs., 62, 62t
knowledge assessments for, 66
“Cuff inflation hypertension,” 144
Culture, as hypertension factor
in Hispanics, 483, 485
in South Asians, 495–496
Cushing’s syndrome
hypercortisolism features in, 149
hypertension related to, 148–149
ectopic ACTH excess and, 109–110
glucocorticoid resistance and, 107t, 108
pituitary-dependent, 109–110, 149
resistant hypertension relate to, 501t, 503
Cutaneous malignancy, post-heart transplant, 348
CVD. See Cardiovascular disease (CVD).
Cyclic guanosine monophosphate–dependent protein
kinase, vascular tone and, 33, 34f
Cyclooxygenase-2 (COX-2) inhibitors
angiotensin-converting enzyme inhibitors and, 241
resistant hypertension related to, 508, 508t
Cyclophosphamide, for metastatic pheochromocytoma,
130
Cyclosporine
hypertension related to (CAH), 146
renal effects of, 277
transplant hypertension and, 361, 362, 363
regimen modifications, 366–367
CYP2D6 (cytochrome P-450 2D6), 539
inhibitors of, 539
Cyproheptadine, for ACTH-producing tumors, 110
Cystatin C, in chronic kidney disease, 186
Cytochrome P-450 2D6 (CYP2D6), 539
inhibitors of, 539
Cytokines, vascular remodeling and, 38, 38f
D allele, of ACE gene, 27
Dabl Educational Web site, of blood pressure
measurement devices, 61, 70, 91
Dacarbazine, for metastatic pheochromocytoma, 130
Danazol, hypertension related to, 145
Danish Verapamil Infarction Trial (DAVIT), 337
Darusentan, 297
DASH diet trial. See Dietary Approaches to Stop
Hypertension (DASH).
Data analyses
in meta-analyses, 316–317, 318
of ambulatory blood pressure, in clinical trials,
88–89, 89t
different class comparisons, 89
for chronotherapeutic agent delivery, 90
for chronotherapeutic agent effects, 89–90, 90t
same class comparisons, 89
of home blood pressure readings
sample size and, 81
standard deviation in, 72, 76
treatment efficacy and, 79, 79f
Data collection, in meta-analyses, 318
Databases
Cardiac Transplant Research, 348
of clinical practice guidelines, 552
of genetic studies, 16, 18
DAVID (Dual Chamber and VVI Implantable
Defibrillator) trial, 345
DAVIT (Danish Verapamil Infarction Trial), 337
Day of week, home blood pressure monitoring and, 72,
73, 73t
Daytime blood pressure, ambulatory monitoring of,
85–86, 86f
in clinical trials analysis, 88–90, 89t, 90t
DBP. See Diastolic blood pressure (DBP).
DD genotype, of angiotensin-converting enzymes,
246
Death outcome. See Mortality.
Debrisoquine, 539
Decision making
individual, evidence-based, 551
patient participation in, 532
Decision-support tools, for disease management
programs, 532
Decongestants
elderly patients’ use of, 458
nasal, hypertension related to, 146
Dementia, 401
Alzheimer’s, 164, 170, 401
hypertensive, 184
in untreated hypertension
Binswanger’s, 165, 401
vascular, 164, 401–402. See also Vascular dementia.
Demographics
of cerebrovascular disease, 183
of heart failure, 181
of left ventricular hypertrophy, 178
Dendroapis natriuretic peptide (DNP), mediating role
of, 41f, 42
Deoxycorticosterone (DOC), excess production of,
hypertension related to, 106–108, 107t
Deoxyribonucleic acid (DNA)
effects of
latent, 22
statistical estimation of, 15–16
variants of expression, 25
Department of Commerce, U.S., Bureau of Standards,
551

Department of Health and Human Services, U.S.,
representation in education program, 552,
552t–553t
Depression, β-adrenergic blockers and, 236
Dermatitis, diuretic-induced, 227
Desflurane, hypertension related to, 145
Desmopressin, for pituitary-dependent Cushing’s
syndrome, 149
DETAIL (Diabetics Exposed to Telmisartan and
Enalapril), 357
Detection, of hypertension. See Diagnosis.
DEW-IT (Diet, Exercise, and Weight Loss Intervention
Trial), 374, 377t
Dexamethasone
for adrenocortical enzyme deficiency, 108
for glucocorticoid resistance, 108
for renal potassium-wasting disorders, 107t, 109
Dexamethasone suppression test, for hypercortisolism
diagnosis, 109–110, 149
Diabetes and Hypertension Cardiovascular Events with
Ramipril (DIABHYCAR), 159f
Diabetes mellitus (DM), hypertension and, 406–415
arterial stiffness with, 169, 408–409, 409f
as risk factor, 7, 8f–9f
cross-classification of groups, 12, 12f
global prediction and, 191–192, 196
inherited, 29
blood pressure goal recommendations for, 7
blood pressure nondipping fluctuations in, 413
cardiometabolic syndrome vs., 406, 407t, 409. See
also Metabolic syndrome.
CHEP 6 guidelines for, 564, 564t, 565
coronary artery disease risk with, 327, 328t
dysautonomia in, 413
dyslipidemia and, 418, 419f, 423
end-stage renal disease resulting from, 163–164
hypertension management with, 357–358, 357t
gestational, 236
global cardiovascular risk and, 191–192
in black population, 196, 474
home blood pressure monitoring and, 77
in African Americans, 196, 474
in chronic kidney disease trials, 353t, 354, 354f, 355
JNC 7 guidelines on, 555, 556t
mortality rates with, 406
new-onset, calcium channel blockers associated with,
275–276
obesity-related hypertension in. See Obesity.
pathophysiology of, 408–409, 409f
angiotensin II receptor blockers as, 408, 409,
411–412
thiazide diuretics as, 412
perioperative hypertension and, 512, 513t, 514, 515f
peripheral artery disease associated with, 384
pharmacologic treatment of, 410–413
α-adrenergic blockers as, 413
β-adrenergic blockers as, 236, 406, 412–413
angiotensin-converting enzyme inhibitors as, 242,
244–245, 244f, 406, 408, 409, 410–411
angiotensin II receptor blockers as, 244, 245,
257–258, 265
calcium channel blockers as, 280–281, 412
clinical trial meta-analysis results, 323, 323f, 411,
411t
clonidine in, 413
hydralazine in, 413
type 2 diabetes associated with, 414
preeclampsia and, 435
prevalence of, 406, 407f
pulse pattern in, 413
rate of concurrence between, 418, 419f
redefining hypertension for, 54–55
resistant hypertension and, 498, 500
stroke association with, 395, 397
stroke-related deaths with, 406, 407, 408, 408f
target organ damage with, 406, 407, 408f, 413
transplant hypertension and, 363, 364
treatment strategies for
additional considerations with, 413
diet as, 409–410
exercise as, 410
pharmacologic, 410–413
weight loss as, 409–410
type 1 (insulin-dependent). See Type 1 diabetes
mellitus.
Diabetes mellitus (DM), hypertension and (Continued)
type 2 (non–insulin-dependent). See Type 2 diabetes
mellitus.
WGTF 4 guidelines for, 558, 560
Diabetes Reduction Approaches with Medication
(DREAM) study, 414
Diabetic cardiomyopathy, 413
Diabetic nephropathy
angiotensin-converting enzyme inhibitors for, 239,
240, 240t, 244–245, 357
calcium channel blockers cautions with, 280–281
CHEP 6 guidelines for, 564t
microalbuminuria with, 409
prevalence of, 409
Diabetic retinopathy, 407, 408f
angiotensin-converting enzyme inhibitors effect on,
244
Diabetics Exposed to Telmisartan and Enalapril
(DETAIL), 357
DIABHYCAR (Diabetes and Hypertension
Cardiovascular Events with Ramipril), 159f
Diacylglycerol, in α1-adrenoceptor activation, 287, 287f
Diagnosis, of hypertension
ambulatory blood pressure classifications in, 53–54,
54t. See also Ambulatory blood pressure
monitoring (ABPM).
CHEP 6 guidelines for, 561, 562t–563t, 565f
definitions for, 3, 49–55
emergency management and, 518, 519f
guidelines for. See Clinical practice guidelines
(CPGs).
home monitoring for, 77–78, 78f. See also Home
monitoring of blood pressure (HMBP).
in children and adolescents, 447–449, 449f
WGTF 4 guidelines for, 558, 559t, 560
JNC 7 guidelines for, 553, 554t, 555
measurement accuracy concerns, 144
mineralocorticoid excess and, 106–116. See also
Mineralocorticoid excess states.
office reading selection and, 64. See also Office
measurement of blood pressure.
pheochromocytoma and, 27t, 119–130. See also
Pheochromocytoma.
rare and unusual causes, 145–150
renovascular, 95–101. See also Renovascular
hypertension.
sleep apnea and, 134–141. See also Sleep apnea.
staff knowledge and, 64–66, 65f
WHO guidelines for, 53, 71, 493, 494, 496
Diarrhea, angiotensin II receptor blockers causing, 264
Diastolic blood pressure (DBP)
age factor of, 5, 169, 170f
coronary heart disease relationship to, 171, 171f,
328, 330f
as drug research endpoint, 535, 543, 546
average reached, prior to isolated systolic
hypertension, 171, 171f
body mass index impact on, 6
coronary heart disease risk and, 157, 158f
in hypertension definition, 3
classifications of, 53–54, 53f, 54t
in hypertension sequelae, importance of, 8–10, 9t
in perioperative hypertension, 514–515, 515f
in pulse pressure, 5, 11–12
in staging systems, 7
mean, for coronary perfusion, 333–334
measurement of. See Blood pressure
measurement/monitoring.
stroke risk related to
primary, 394, 395f, 396f
secondary, 397–398, 398f
weight loss effect on, 372–378, 373t, 374f–376f, 377t
Diastolic function/dysfunction, in heart failure, 179t,
181
aging impact on, 340–341
treatment of, 342–348
Diastolic hypertension, 3
classifications of, 53–54, 53f, 54t
in children, 440
WGTF 4 guidelines for, 558, 559t
in elderly patients, systolic hypertension with,
459–460, 459t
isolated
age factor of, 169, 170f
home monitoring and, 77
Index 589
Diastolic hypertension (Continued)
pathophysiology of, 169, 170f
prehypertension risk for, 166
treatment guidelines for
CHEP 6, 561, 562t–563t
international comparisons of, 572–574, 572f, 572t,
573t, 575t
JNC 7, 554t
Diazoxide, 299
intravenous, for hypertensive emergencies, 519,
521–522, 521t
Dichloroisoproterenol, molecular structure of, 232,
235f
Didima study, of home blood pressure monitoring, 74
Diet, 201–209
as risk factor, 6, 50, 146, 147
genetic variants of, 23, 42, 203, 207
in children and adolescents, 207–208
blood pressure and, 201–207
behavioral intervention trials on, 202, 207
beneficial effects with obesity, 372–376, 374f–376f,
377t
effects of multiple changes, 207
evidence of influence, 201, 208–209, 208t
factors that reduce, 201–205
factors with limited effects, 205–207
gene interactions with, 203, 207
in special populations, 207–208
cardiovascular disease risk and, 201, 202f, 203, 208
coronary heart disease and, 193–194
DASH. See Dietary Approaches to Stop Hypertension
(DASH).
drug absorption effects of, 539
for chronic disease management, 530, 532
for diabetes-related hypertension, 409–410
for dyslipidemia, 421, 423, 424
for preeclampsia, 435
for weight loss, 372–376, 373t, 377t
lifestyle modifications and, 205, 207, 372
of children and adolescents, 207
therapeutic changes in, 449–450, 449f
WGTF 4 guidelines for, 558
reduced-sodium. See Sodium restriction.
renal disease risk and, 201, 203, 207
salt-sensitive hypertension pathology and, 31–32, 32f
transplant hypertension and, 364
typical U.S., 372
Diet, Exercise, and Weight Loss Intervention Trial
(DEW-IT), 374, 377t
Dietary Approaches to Stop Hypertension (DASH), 201,
208
blood pressure by week results of, 205, 205f
CHEP 6 guidelines for, 564
for African Americans, 474, 477
for Canadians, 564
for children and adolescents, 449–450, 449f, 558
for diabetic patients, 410
for elderly patients, 459, 459t
for obesity, 373–374, 373t, 374f, 377t
for peripheral artery disease, 389
international comparisons of, 566, 575
multiple dietary changes in, 207
potassium intake data from, 204, 204f
resistant hypertension and, 500f, 504, 504t
sodium intake data from, 202–203, 203f
transplant hypertension and, 364
trial results, 201, 202–203, 203f–205f, 204, 205
Dietary Approaches to Stop Hypertension (DASH)-Low
Sodium, trial results, 373–374, 374f, 377t
Digitalis
for heart failure, 342, 343
toxicity of, diuretics and, 227
Dihydropyridines
adverse effects of, 273, 274t, 275, 275f
arterial effects of, 279–280
clinical outcome studies on, 271–272
combination therapy with, 276–277, 276t
contraindications for, 280–281, 282t
dementia and, 184
for diabetes-related hypertension, 411t, 412
for East Asian populations, 489, 490
for elderly patients, 460, 461, 463
for obesity-related hypertension, 379
for resistant hypertension, 505f, 506
pharmacology of, 268–269, 269f, 270t
590 Index
Dihydropyridines (Continued)
renal effects of, 277, 357
special indications for, 281, 282t
Diltiazem
β-blocker combinations with, 236
clinical outcome studies on, 272t, 276, 276t
for resistant hypertension, 505f, 506
for transplant hypertension, 365t, 366
home monitoring evaluation of, 78
Dipping/dippers
ambulatory blood pressure monitoring of, 85–86,
86f, 87
nighttime, in blood pressure, 85–86, 86f
Direction bias, in blood pressure measurement, 64, 65f
Disease management services, 527–533
blood pressure control trends with, 527
challenges of, 527–528
chronic care model of, 528, 531, 532f
integrated model of, 531–533, 532f
benchmarks of, 531
care delivery structure and process in, 531–532
group vs. individual, 531
team member responsibilities, 532–533
nurse case management as, 528–529
pharmacists in, 529–531
clinic model of, 530
community pharmacy model of, 529–530
nurse collaboration model of, 530–531
physician collaboration model of, 530
trends of, 529
Disopyramide, post-heart transplant indications for,
347
Distal tubule, diuretics action in, 213, 214f, 214t
Disulfiram, hypertension related to, 147
Diuretic therapy, 213–227
adaptation to, 216
adverse effects of, 223–226
angiotensin II receptor blockers combined with, 256,
258, 259, 261
breast milk concentrations of, 438
classes of, 213–216. See also specific class.
carbonic anhydrase inhibitors, 213
distal potassium-sparing, 215–216
loop, 213–215, 215f
nephron sites of action, 213, 214f
specific effect on hypertension, 218
thiazide, 215
for angina, unstable, 336
for chronic kidney disease, 357, 357t
for coronary artery disease, 329, 331t
for diabetes-related hypertension, 408, 410f, 411t,
412
type 2 diabetes pathology and, 414
for heart failure, 342, 343
for hyperparathyroidism, 150
for hypertension, 217–223, 270
angiotensin-converting enzyme inhibitors with,
242
β-blocker combinations with, 233–234, 236
CHEP 6 guidelines for, 562t, 564t, 565, 565f
chronic phase of, 218
class effect in, 218
clinical trials on, 218–219, 220f–221f
patient population responses, 219, 222, 222f,
224
combination, 217, 223, 224–225
dose-response relationship of, 213–214, 215f, 223
general considerations for, 217, 223
in African Americans, 222, 475–476, 496
in children and adolescents, 450, 452t–453t
in East Asian populations, 489, 490
in elderly patients, 219, 459, 460, 461, 461t, 463,
463t
in obesity, 378, 380t
isolated systolic, 174
JNC 7 guidelines for, 556–557, 556t, 557f
left ventricular hypertrophy regression with,
222–223
lipid-lowering drug interactions with, 420, 420t,
421, 424
mechanism of action, 217–218, 217f
renovascular, 102
responsive patient populations, 219, 222
stepped-care approach to, 217, 223
for hypertensive emergencies, 518, 519
Diuretic therapy (Continued)
for non-ST-segment myocardial infarction, 336
for pregnancy-related hypertension, 433t, 434, 436
for primary aldosteronism, 114, 114f
postoperative, 115
for renal arteriopathy, 33
for resistant hypertension, 500, 501t, 503, 506, 507,
509
importance of, 504–505, 505f
for ST-segment elevation myocardial infarction, 337
for stroke prevention, primary, 395, 396, 397, 397f
for transplant hypertension, 365, 365t, 366
for vascular dementia, 401
guidelines for, international comparisons of,
573–574, 575f
historical studies on, 305, 306
in resistant hypertension, 147, 498
loop. See Loop diuretics.
meta-analyses of, 318, 319t, 321f, 322
metabolic abnormalities with, 226–227
neurohormonal response to, 216–217
adaptive, 223, 224f
outcome studies on, 307, 309, 310
pharmacogenetic studies of, 21, 25, 29
pharmacokinetics of, 213, 214t
resistance to, 215, 216
steroid therapy indication for, 145
thiazide. See Thiazide diuretics.
Diurnal variations, in blood pressure. See Nocturnal
entries.
Dizziness
angiotensin II receptor blockers causing, 264
with α1-adrenoceptor antagonists, 292
DM. See Diabetes mellitus (DM).
DNA. See Deoxyribonucleic acid (DNA).
DNP (Dendroapis natriuretic peptide), mediating role
of, 41f, 42
DOC (deoxycorticosterone), excess production of,
hypertension related to, 106–108, 107t
Doctor of Pharmacy degree, 529
Doctors. See Physicians.
Dopamine, urine vs. plasma studies of
for pheochromocytoma, 121f, 122, 123
renal failure and, 124
Dopamine-1 receptor agonists
for children and adolescents, 450, 454t
new investigations on, 296
Dopamine-2 receptor agonists, peripheral, new
investigations on, 296
Dopamine receptors
candidate genes of, 19t
subtypes of, 296
Dopexamine, 296
Doppler flow studies
for arterial assessment, 182
mitral, for heart failure assessment, 179t, 181
Doppler ultrasound, for renovascular hypertension, 95,
96
performance characteristics of, 97t, 99
resistant, 501t, 502
Dor procedure, for heart failure, 346
Dose dumping, 539
Dose-response control group, in new drug
development, 540, 541, 541f
titration designs for, 541–542
Dose-response studies
on angiotensin-converting enzyme inhibitors, 242
on diuretics, 213–214, 215f, 223
on new drugs, 540, 541, 541f
titration designs for, 541–542
on potassium intake, 204, 204f
Dose selection, in new drug development, 542
Dose titration, in new drug development, 542–543
dose-response control group and, 541–542
Dosing interval, in new drug development, 542
Doxazosin, 219, 243, 258
for diabetes-related hypertension, 413
for heart failure, 341
for hypertension, 288, 290, 290f
in African Americans, 475, 476
in children and adolescents, 450, 453t
in elderly patients, 459
for obesity-related hypertension, 379
for stroke prevention, 397
for transplant hypertension, 366
Doxazosin (Continued)
historical studies on, 306
metabolic effects of, 291
outcome studies on, 307
pharmacology of, 288, 289f
DRASTIC (Dutch Renal Artery STenosis Intervention
Cooperative), 103
DREAM (Diabetes Reduction Approaches with
Medication) study, 414
Dreams, β-adrenergic blockers and, 236
“Drive-by” renal angiography, for renovascular
hypertension, 100–101
Drug absorption, food impact on, 539
Drug abuse, hypertension related to, in children and
adolescents, 446, 446t, 560
Drug allergy(ies), to diuretics, 227
Drug concentrations
highest achieved after dosing (Cmax), 538
median effective (EC50), 540
peak and trough ratio, blood pressure monitoring for
ambulatory, 89
in home, 72, 80
time integration with, 538
time of peak (Tmax), 538
trough before next dose (Cmin), 538
Drug-disease interactions, regulatory perspectives of,
545
Drug dosing. See Dose entries.
Drug-drug interactions
adverse
with angiotensin II receptor blockers, 256
with diuretics, 227
disease management consideration of, 532
regulatory perspectives of, 537, 539, 545
Drug exposure, area under the curve of, 538
Drug intolerance, objective vs. subjective, 506
Drug screens, for adolescents, 560
Drug therapy. See Pharmacotherapy; specific agent or
drug classification.
Drug toxicity(ies), diuretic-induced, 227
Dual Chamber and VVI Implantable Defibrillator
(DAVID) trial, 345
Dual-chamber pacing
for heart failure, 345
VDD, for dilated cardiomyopathy, 345
Dubendorf study, of home blood pressure monitoring,
74
Dutch Renal Artery STenosis Intervention Cooperative
(DRASTIC), 103
Dutch Transient Ischemic Attack trial, 159f
Dysarthria-clumsy hand syndrome, 183
Dysautonomia, diabetes-related hypertension and, 413
Dyslipidemia, in hypertension, 418–424
as risk factor, 7, 8f, 12, 418
in African-American population, 196, 418
newer issues of, 195
CHEP 6 guidelines for, 564t
clinical trials on, 418
coronary artery disease risk with, 327, 328t, 418
predictors of, 419
treatment indications for, 418, 419t, 420, 422, 423
diabetes mellitus and, 408–409, 409f
genetics of, 418, 421
global cardiovascular risk and, 190, 191f, 196, 418
therapy indications for, 422, 422t
metabolic syndrome and, 418–419, 419t
therapy for, 422, 422t
pathophysiology of, 39
peripheral artery disease associated with, 385, 388
rate of concurrence between, 418, 419f
treatment of, 424
adherence issues in, 423–424
diet in, 421, 423, 424
lifestyle changes in, 418, 419t, 421, 423
metabolic syndrome and, 422, 422t
pharmacotherapy for
estimated need for, 418, 419t
interactions with, 419–421, 420t
specific principles for, 423
vascular wall interactions, 419, 419f
Dysrhythmias, cardiac
β-blocker cautions with, 236
blood pressure measurement and, 64
diuretic-induced, 224, 225, 226
heart transplant and, 347

Dysrhythmias, cardiac (Continued)
investigational drug-related, 539, 540, 545
perioperative hypertension and, 513, 513t, 514, 515f
with heart failure, electrical therapy for, 344–345
E/A wave ratio, in heart failure, 179t, 181
Early morning blood pressure surge, 86, 89
East Asians, hypertension in, 487–490
Chinese populations, 487, 488t
detection disparities in, 484f
genetic studies on, 19t
Japanese populations, 487–488, 488t
Korean populations, 488, 488t
Native Hawaiians, 488, 488t
prevalence trends of, 4, 4t, 487–488, 488t
sociocultural barriers and, 490
stroke prevention trials, 398, 398f
stroke risk and, 394, 395f, 396
treatment of
considerations for, 488–489
efficacy of, 487
outcome studies of, 489–490
side effects with, 487, 490
Eating habits/behavior, weight loss and, 372
Eccentric left ventricular hypertrophy, 178–179, 179t
ECF. See Extracellular fluid (ECF).
ECG. See Electrocardiography (ECG).
Echocardiography
for angina assessment, 335
for children and adolescents, 447, 448
for coarctation of the aorta, 148
for heart failure assessment, 179t, 181
aging impact on, 341
staging, 342
for left ventricular hypertrophy assessment, 179t, 180
stress, for ischemic heart disease assessment, 179t, 180
transesophageal, for stroke assessment, 184
transthoracic, for stroke assessment, 184
Eclampsia
hypertensive emergency with, 517, 518, 518t
management of, 522
in pregnancy, 429, 436. See also Preeclampsia.
Ectopic corticotropin syndrome, 148
diagnostic tests for, 149
Ectopy, ventricular, diuretic-induced, 224
Edema
in preeclampsia, 435, 436
peripheral, from calcium channel blockers, 273, 274t,
275, 275f
pulmonary. See Pulmonary edema.
EDHF (endothelium-derived hyperpolarizing factor),
substance P and, 43
Education
patient
for disease management, 530, 532
international comparisons of, 572t, 573t, 574–575
public. See also National High Blood Pressure
Education Program (NHBPEP).
for Hispanics, 485
Effectiveness criteria, in new drug development, 535,
540–543, 541f
Effects of Amlodipine and Lisinopril on Left Ventricular
Mass and Diastolic Function (ELVERA) study,
279
Efferent output, of sympathetic nervous system, 29, 31f
Efficacy of Nitric Oxide in Stroke (ENOS), 399
eGFR (estimated glomerular filtration rate), in chronic
kidney disease, 186, 186t
Ejection fraction, in heart failure, 181, 341
transplant indications based on, 346
treatment effects on, 344, 345, 346
Ejection rate, of left ventricle, in isolated systolic
hypertension, 171, 173
Elasticity, arterial, reduction of, 36–37, 166. See also
Arterial stiffness.
Elastin, arterial stiffness related to, 36
Elderly patients
hypertension in, 457–465
antihypertensive therapy for, 458–463
goals of, 461–463
lifestyle modifications as, 458–459, 459t
pharmacologic treatment as, 159f, 459–465
blood pressure control rates with, 457
Elderly patients (Continued)
cardiovascular disease risk and, 457
Cardiovascular Health Study of, 8–9, 9t
clinical evaluation of, 458
cognitive function and, 159f, 164, 184
pharmacotherapy effects on, 463–464, 463t
defining, 49–50, 50f
diet and, 208
epidemiology of, 12–13, 13t, 457–458
hormone replacement therapy and, 458, 464–465,
465t
isolated systolic
cardiovascular disease risk and, 457–458
pathophysiology of, 457
pharmacologic treatment of, 460–461, 460t
goals of, 461–463, 462t
prevalence of, 457
measurement problems of, 144
“mild,” 11
obstructive sleep apnea syndrome and, 136, 139
pharmacologic treatment of, 459–465
angiotensin-converting enzyme inhibitors as,
242, 245
β-adrenergic blockers as, 236
clinical trials on, 159f, 458, 462t, 463t
cognitive impairment related to, 463–464, 463t
diuretics as, 219, 222f
for combined systolic-diastolic, 459–460, 459t
for isolated systolic, 460–461, 460t
for very old patients, 464
initial agent choice in, 461, 461t
pseudohypertension vs., 458
resistant, 499t, 507, 509
risk factors for, 13
systolic blood pressure importance, 10
systolic-diastolic, therapy for, 459–460, 459t
weight loss trials and, 375, 377t
new drug development and, 539
postural hypotension in, 458, 463
Electrocardiography (ECG)
diuretics effect on, 224, 225, 226
for angina assessment, 334–335
for children and adolescents, 448
for elderly patients, 458
for hypertensive emergencies, 518
for ischemic heart disease assessment, 179t, 180
for left ventricular hypertrophy assessment, 179–180,
179t
with heart failure, 341
for perioperative hypertension evaluation, 513, 513t,
515, 515f
for stroke assessment, 184
in new drug development, 539, 540, 545
Electrolytes. See also specific electrolyte or imbalance, e.g.
Hyperkalemia.
angiotensin II receptor blockers impact on, 264
dietary, weight loss targets for, 372, 373t
diuretic therapy impact on, 213, 214f, 217
adaptive, 216, 224f
adverse effects, 223–226
Electronic blood pressure devices
calibration of, 60, 60f, 61
in virtual hypertension clinic, 81, 81f
teletransmission of readings, 82
individual patient accuracy of, 61, 64
inspection for quality assurance
ambulatory monitoring and, 90–91
in office, 66
Electronic monitoring, of pharmacotherapy adherence,
507
Electronic stethoscope, 61
Elimination, physiologic
new drug development and, 539
of β-adrenergic blockers, 234t
of angiotensin-converting enzyme inhibitors, 239
of angiotensin II receptor blockers, 256
ELITE (Evaluation of Losartan in the Elderly), 258,
259f, 261
ELITE-2 (Evaluation of Losartan in the Elderly-2), 258,
259f, 261
ELSA (European Lacidipine Study on Atherosclerosis),
272t, 275, 276t, 278, 278t, 279, 319t
ELVERA (Effects of Amlodipine and Lisinopril on Left
Ventricular Mass and Diastolic Function)
study, 279
Index 591
Emax (maximum ventricular elastance), 540
Embolism, artery-to-artery, stroke related to, 392, 393f,
394
ENaC. See Epithelial sodium channel (ENaC).
Enalapril, 240t, 242
clinical trials on, 55, 245, 247, 249, 272t
for hypertension
in children and adolescents, 450, 451t
intravenous, 450, 454t
in East Asian populations, 489
in elderly patients, 460
for perioperative hypertension, 514
for transplant hypertension, 365t, 366
historical studies on, 306
home monitoring evaluation of, 79, 79f, 80
omapatrilat vs., 298–299
pharmacology of, 239
Enalaprilat, intravenous, for hypertensive emergencies,
519, 520t, 521–522
Encephalopathy
hypertensive, 184
hypertensive emergency with, 517, 518, 518t
in children, 561
management of, 522
End-of-phase-2 (EOP2) meetings, 537
End-stage renal disease (ESRD)
angiotensin-converting enzyme inhibitors and,
244–246, 245f, 246t
angiotensin receptor blockers and, 257–260, 356–359
blood pressure as predictor of, 352, 352f
calcineurin inhibitors causing, 362
diabetes mellitus and, 406, 409, 410–411
hypertension management with, 357–358, 357t
in African Americans, 469
natural history of, 163–164, 163f
outcome studies on, 307–308, 308f
prevalence of, 351, 352f
progression and staging of, 186, 186t, 352t
Endarterectomy, carotid, for stroke prevention,
400–401, 400t
Endocannabinoid-1 receptor antagonists, new
investigations on, 300
Endocrine disorders
in children and adolescents, 448
hypertension related to, 446, 446t
pheochromocytoma vs., 119, 120t
Endomyocardial biopsy, post-transplant, 347, 348
Endopeptidase inhibitors, neutral, new investigations
on, 298–299, 299f
Endopeptidases, vascular tone and, 38, 299f
Endothelial function/dysfunction
α-adrenergic blockers effects on, 291
angiotensin-converting enzyme inhibitors effects on,
242
arterial stiffness related to, 36, 36f
calcineurin inhibitors impact on, 362
calcium channel blockers effects on, 279
developmental models of, 40
heart failure impact on, 341
in African Americans, 472, 474
in chronic kidney disease, 351–352
in diabetes mellitus, 408, 409f, 413
in dyslipidemia and hypertension, 419, 419f, 423
in preeclampsia, 430f, 435, 436
left ventricular hypertrophy and, 179
obstructive sleep apnea syndrome and, 138, 138f, 140
Endothelial nitric oxide synthase (eNOS), reduction of, 36
Endothelin (ET-1)
in African Americans, 469t, 471
mediating role of, 41
Endothelin receptor antagonists
new investigations on, 296–297
subtypes of, 296
toxicity cautions with, 41
Endothelium, in arterial assessment, 182
Endothelium-derived hyperpolarizing factor (EDHF),
substance P and, 43
Endurance-based exercise, for peripheral artery disease,
388–389
ENOS (Efficacy of Nitric Oxide in Stroke), 399
eNOS (endothelial nitric oxide synthase), reduction of, 36
Enrasentan, 297
Enrollment, in clinical trials, 313
Enteric nervous system, vascular smooth muscle cell
regulation by, 286
592 Index
Environment
as hypertension risk
in African Americans, 469t, 470–472
in India population, 493–495, 494t, 495t
mercury sphygmomanometer concerns for, 58–59
Enzymes, oxidizing, in liver, 539
EOP2 (end-of-phase-2) meetings, 537
Ephedra, resistant hypertension related to, 508, 508t
Ephedrine, 146, 236, 458, 514
EPHESUS (Eplerenone Post-Myocardial Infarction
Heart Failure Efficacy and Survival Study), 344
Epidemiological Follow-up Study, of NHANES I, 469
Epidemiology, of hypertension, 3–5
definition approach based on, 50–51, 51f–52f
genetics in, 15–23. See also Genetics.
global burden and, 4–5
global cardiovascular risk in, 190–196
in older individuals, 12–13, 13t
obstructive sleep apnea syndrome and, 134–135, 136t
pathophysiology in, 25–43. See also Pathophysiology.
prevalence trends
by race/ethnicity, 4, 4t
by sex, 4, 4t
in U.S., 3–4, 4f, 4t
risk factor association criteria, 3
secular trends, 3–4, 4f, 4t
term definitions for, 3
Epinephrine/adrenaline
β-blocker combinations with, 236
pathophysiologic role of, 30, 30f
urine vs. plasma studies of
for pheochromocytoma, 121f, 122, 123
renal failure and, 124
Episodic hypertension, pheochromocytoma and, 123
Epithelial sodium channel (ENaC)
aldosterone role in, 39–40
candidate genes of, 19, 19t
pathophysiologic mechanisms of, 25–26, 27t, 28f
Eplerenone
adverse effects of, 225, 227
for hypertension, 295–296
for primary aldosteronism, 115
mechanism of action, 40
pharmacokinetics of, 214t, 215–216
Eplerenone Post-Myocardial Infarction Heart Failure
Efficacy and Survival Study (EPHESUS), 344
Eprosartan
for stroke prevention, 258, 259f, 263, 398
pharmacologic properties of, 255t, 256
Equivalence trials, superiority vs. noninferiority,
307–310
Erectile function
α1-adrenoceptor antagonists for, 291–292
diuretics effect on, 227
drug therapy for, hypertension related to, 145
Erythropoietin
angiotensin-converting enzyme inhibitors effect on,
249–250
angiotensin receptor blockers effect on, 264
hypertension related to, 149
injections, for transplant hypertension, 366
Esmolol
elimination characteristics of, 234t
intravenous
for children and adolescents, 450, 454t
for hypertensive emergencies, 519, 520t, 521–522
molecular structure of, 232, 235f
pharmacokinetic properties of, 232–233, 233t
ESRD. See End-stage renal disease (ESRD).
Essential hypertension
developmental phases of, 34
in children and adolescents, 446–447
characteristic findings of, 448
renal microvascular disease and, 34–35, 35f
Estimated glomerular filtration rate (eGFR), in chronic
kidney disease, 186, 186t
Estrogen replacement therapy, hypertension related to, 145
Estrogens
adrenocortical enzyme deficiency impact on,
106–108, 108f
oral, hypertension related to, 145
synthesis pathway of, 108f
ET-1 (endothelin)
in African Americans, 469t, 471
mediating role of, 41
Ethacrynic acid, diuretics interaction with, 227
Ethics, in clinical trials, 312–313
Ethnicity. See Race/ethnicity.
EUCLID (EURODIAB Controlled Trial of Lisinopril in
Insulin-Dependent Diabetes Mellitus) study,
243
EURODIAB Controlled Trial of Lisinopril in Insulin-
Dependent Diabetes Mellitus (EUCLID) study,
243
EUROPA (European Trial on Reduction of Cardiac
Events with Perindopril), 159f, 162, 162f, 243
European Lacidipine Study on Atherosclerosis (ELSA),
272t, 275, 276t, 278, 278t, 279, 319t
European Multicenter Orlistat Group, 376
European Society of Cardiology, 53, 55
on obstructive sleep apnea syndrome, 141
European Society of Hypertension
ambulatory monitoring device protocols, 91
definition recommendations, 53, 55
guidelines of
American guidelines vs., 571–575
differences, 572–575, 573t
major agreements, 571, 572f, 572t
on first-choice drugs, 573–574, 574f–575f
on prehypertension, 572
on total cardiovascular risk, 573
on treatment indications, 574
other issues in, 574–575
British guidelines vs., 575, 575t
home monitoring recommendations, 69
on obstructive sleep apnea syndrome, 141
European Trial on Reduction of Cardiac Events with
Perindopril (EUROPA), 159f, 162, 162f, 243
European Working Party on Hypertension in the
Elderly (EWPHE), 159, 159f, 161f, 162f, 459t
Evaluation, of hypertension
blood pressure for. See Blood pressure
measurement/monitoring.
guidelines for, international comparisons of,
571–575, 572t, 573t, 575t
Evaluation of Losartan in the Elderly (ELITE), 258,
259f, 261
Evaluation of Losartan in the Elderly-2 (ELITE-2), 258,
259f, 261
Evidence-based clinical practice guidelines, 551, 552
Evidence-based health policies and procedures, 551
Evidence-based individual decision making, 551
Evidence-based medicine
for angiotensin-converting enzyme inhibitors, 240–241
for antihypertensive drugs, home monitoring and, 80
for diet, 201, 208–209, 208t
in disease management programs, 528, 532, 551
Evidence-Based Recommendations Task Force, CHEP
2005, 561
EWPHE (European Working Party on Hypertension in
the Elderly), 159, 159f, 161f, 162f, 459t
Exclusivity criteria, for new drug study, 546
Exercise/exercise programs
CHEP 6 guidelines for, 564, 565f
coronary heart disease and, 193
for African Americans, 477
for children and adolescents, 558, 559t
for diabetes-related hypertension, 410
for peripheral artery disease, 388–389
for transplant hypertension, 364
for weight loss, blood pressure response to, 374, 376,
377t
home blood pressure monitoring and, 73t, 74
pregnancy-related hypertension and, 432
Exercise testing, for angina assessment, 335
Exogenous substances, interfering/competing, resistant
hypertension related to, 500f, 507–508, 508t
EXP-3174, 256
Extra-adrenal pheochromocytomas, 119, 129
Extracellular fluid (ECF)
reduction with diuretics, 216, 217, 218
adaptive changes to, 223, 224f, 225, 226
sympathetic activity stimulation by, 30
Extrauterine life, intrauterine life transition to, 440
FACET (Fosinopril Amlodipine Cardiac Events Trial),
271, 272t, 280
Factitious pheochromocytoma, 124
Factorial study, of new drugs, 541, 541f
fixed-combinations in, 544, 544f
Familial paraganglioma, secondary hypertension related
to, 120, 121t, 122, 129
Family Blood Pressure Program (FBPP), 18, 20
Family history of hypertension, in children and
adolescents, 446, 448
Family members, home blood pressure monitoring by, 71
Family studies, of genetics, 17, 18
twins in, 15, 25
Fasting glucose
in diabetes mellitus, 406
in metabolic syndrome, 406
Fasudil, clinical trials on, 33
Fat burden, in obesity, 370, 371t
Fat distribution, in obesity
calculation of, 370, 371t
resistant hypertension and, 509
Fat intake, dietary
blood pressure response to, 6, 206
for weight loss, 372, 373t, 377t
Fat tissue. See Adipose tissue; Adiposity.
Fatty acids
dietary, for weight loss, 372, 373t
free, obesity and, 371f, 372
FBPP (Family Blood Pressure Program), 18, 20
FDA. See Food and Drug Administration (FDA), U.S..
FDA Modernization Act (FDAMA) of 1997, 538, 540,
546
FD&C (Food, Drug and Cosmetic) Act of 1962, 536,
540
FDG (fluoride-18-fluorodeoxyglucose) scintigraphy, for
pheochromocytoma localization, 126, 126f
Federal agencies, of U.S., representation in education
program, 552, 552t–553t
Federal Wide Assurances, for clinical trials, 312
Felodipine
clinical outcome studies on, 272t, 276t
combination formulations of, 233–234
for children and adolescents, 450, 452t
for East Asian populations, 489
renal effects of, 277, 277f
Femoral arteries, peripheral artery disease in, 385
Femoropopliteal lesions, in peripheral arterial disease,
387, 387t
Fenoldopam mesylate, 296
intravenous
for children and adolescents, 450, 454t
for hypertensive emergencies, 519, 520t, 521–522
Fetus
drugs harmful to. See Teratogens.
pregnancy-related hypertension risks for, 431
timing of delivery and, 436
FF (filtration fraction), in chronic kidney disease, 186
FFA (free fatty acids), obesity and, 371f, 372
FHS. See Framingham Heart Study (FHS).
Fiber intake, blood pressure response to, 205–206
Fibrates, for dyslipidemia, 422, 422t
Fibromuscular dysplasia (FMD)
pathologic types of, 93
renovascular hypertension with, 93–94
treatment of, 94, 101
Fifth Report, of Joint National Committee, 169
Filtration fraction (FF), in chronic kidney disease, 186
Financial resources, for Hispanics, 485
Finger monitors
for home blood pressure monitoring, 70
indications for, 144
FIPTs (focal intraretinal periarteriolar transudates), 185,
185t
First-choice drugs, international comparisons of,
573–574, 574f, 575t
First-dose phenomenon, with α1-adrenoceptor
antagonists, 292
Fish oil supplementation, 205, 206
Fixed-dose, dose-response study, placebo-controlled,
540–541, 541f, 544
Fixed-effects model, for meta-analyses, 316
“Flash pulmonary edema,” 181
Flow velocity measurements, in peripheral artery
disease, 386
Fludrocortisone, postoperative, for primary
aldosteronism, 115
Fluoride-18-fluorodeoxyglucose (FDG) scintigraphy, for
pheochromocytoma localization, 126, 126f

FMD. See Fibromuscular dysplasia (FMD).
fms-like tyrosine kinase 1, in preeclampsia, 430t, 435
FOAM (Fosinopril or Amlodipine Multicenter) study,
279
Focal intraretinal periarteriolar transudates (FIPTs),
185, 185t
Folic acid, for dyslipidemia, 424
Follow-up care
in disease management programs
integrated team approach to, 531–533, 532f
practitioner-specific roles, 528–531
JNC 7 guidelines for, 557f
Food. See Diet.
Food, Drug and Cosmetic (FD&C) Act of 1962, 536, 540
Food and Drug Administration (FDA), U.S.
angiotensin II receptor blocker approval, 254, 255t
antihypertensive drug development role, 307, 535,
537–538, 543, 546
Cardiovascular and Renal Drugs Advisory
Committee of, 538, 544, 546
Office of Drug Safety, 538–539
pregnancy drug classification, 432, 433t
ventricular assist device approval, 346
Fosinopril
clinical trials on, 246, 272t, 279, 355
for children and adolescents, 450, 451t
for hypertension, 240t
pharmacology of, 239
Fosinopril Amlodipine Cardiac Events Trial (FACET),
271, 272t, 280
Fosinopril or Amlodipine Multicenter (FOAM) study,
279
Framingham Heart Study (FHS)
isolated systolic hypertension in, 169–171, 170f, 174
resistant, 507
obesity in, 370
on cardiovascular disease
blood pressure measurement and, 58
European approach vs., 193
global risk prediction and, 190, 191f, 196
multivariable risk estimation, 192–193, 192f
outcomes, 7–8, 8f, 11
risk factors, 5–6, 8, 8f, 406
clustering of, 12, 12f
systolic blood pressure importance, 10, 10t
untreated hypertension and, 157, 158, 158f, 162, 165
on coronary artery disease, 327, 328t, 330f
on prehypertension, 166, 572
peripheral arterial disease in, 387, 388f
renal failure data from, 164
South Asians in, 494, 496
stroke risk data from, 160
Framingham Offspring Study, 163, 166
peripheral arterial disease in, 384, 386
Free fatty acids (FFA), obesity and, 371f, 372
Fruits, for weight loss, 372, 373t, 377t
Functional limitations, with peripheral artery disease,
384
Furosemide
adaptation to, 216
for African Americans, hypertensive, 476
for children and adolescents, 450, 453t
for hyperparathyroidism, 150
for hypertension, 216, 218, 227
for primary aldosteronism, postoperative, 115
for resistant hypertension, 504
for transplant hypertension, 365t, 366
outcome studies on, 310
pharmacokinetics of, 214–215, 214t
G-6A polymorphism, 19
G-protein signaling pathway, candidate genes of, 19,
19t, 21
Gaussian curve, of normal home blood pressure, 76
Gemopatrilat, 298
Gender
blood pressure staging and, 7
cardiovascular disease risk based on, 8, 8f–9f
global prediction of, 190, 192, 193f
home blood pressure monitoring and, 72
hypertension definition based on, 6, 49–50, 50f
new drug development and, 539
obstructive sleep apnea syndrome and, 135, 136t, 137f
Gender (Continued)
of children, blood pressure levels based on, 440,
442t–445t
prevalence trends based on, 4, 4t
Gene-diet interactions, blood pressure response to, 23,
42, 203, 207
Gene-environment interactions, 22–23, 22f
Gene mapping, 29
for admixture populations, 17, 20, 21f, 482
Mendelian genes identified by, 17–18, 17t
of haplotypes, 18, 20
Genetic research, on hypertension
context of, 15, 23, 29
study designs for, 16–17
twins in, 15, 25
Genetic syndromes
as risk factor, 6, 15, 234, 446
glucocorticoid-remediable aldosteronism as, 115, 116f
in children and adolescents, 448
hypertension related to, 446, 446t, 447
Mendelian forms of, 17–18, 17t
pathophysiologic mechanisms of, 25–29, 26f, 27t
metabolic syndrome as, 418–419
of pheochromocytoma, 119–122, 121t
Genetic testing, for pheochromocytoma, 119–120, 129
Genetics
of dyslipidemia, 418, 421
of hypertension, 15–23
admixture populations and, 17, 20, 21f, 482
ancestral populations and, 17
association studies on, 17, 18–20, 19t
atrial natriuretic peptide and, 42
case-control studies on, 17, 18–20, 19t
database resources for, 16, 18
during pregnancy, 17t, 27t, 28f
family studies on, 17, 18
of twins, 15, 25
gene-environment interactions, 22–23, 22f
geographic population effects, 18, 20, 21–22
heritability and, 15–16
molecular terminology overview, 16
monogenic forms, 17–18, 17t
pathophysiologic mechanisms, 25–29, 26f
candidate genes in, 26–28
Mendelian forms of, 25–26, 27t, 28f
pharmacogenetic studies of, 20–21, 25
practice implications of, 23, 28–29
racial population effects, 16, 17, 18, 19t, 20, 21–22
risk related to, 6, 15, 234, 446
statistical estimation of effects, 15–16
study designs for, 16–17
study findings on, 17–23
of left ventricular hypertrophy, 179
of obstructive sleep apnea syndrome, 135, 136t
Genome search meta-analysis (GSMA), 18
Genome-wide linkage analysis, 17
Genotype, of angiotensin-converting enzymes, 246
Geographic populations
admixture mapping of, 20, 21f, 482
gene-environment interactions in, 22–23
genetic studies on, 18, 21–22
Geriatric patients. See Elderly patients.
Gestational age
blood pressure relationship to, 440
preeclampsia management based on, 436
Gestational diabetes, 236
Gestational hypertension, 429, 431
GFR. See Glomerular filtration rate (GFR).
GH (growth hormone), chronic hypersecretion of, 150
Ginseng, resistant hypertension related to, 508, 508t
Gitelman’s syndrome, 17t, 25, 27t, 28f
Glitazones, for metabolic syndrome, 422, 422t
Global Burden of Disease Study, 493, 494t
Global epidemiology
in admixture mapping, 20, 21f, 482
of hypertension, 4–5
cardiovascular risk prediction in, 190–196, 573
dyslipidemia and, 418, 422, 422t
South Asian populations and, 493, 494t
of stroke, 392–394, 393f
Global risk, of cardiovascular disease, 190–196
definition of, 423
dyslipidemia and, 190, 191f, 196, 418
therapy indications based on, 422, 422t
epidemiology of, 4–5
Index 593
Global risk, of cardiovascular disease (Continued)
European approach to, 193
Framingham Heart Study on, 190, 191f, 196, 423
in African-American population, 195–196
international comparisons of, 566, 573
lifestyle and, 193–194
lipid-lowering therapies, “global risk” estimates for,
418, 423
multivariate risk estimation, 192–193, 192f–193f
newer issues for, 194–195, 194f
prediction of, 190, 191f, 196
traditional factors of, 190–192, 191f
Glomerular filtration rate (GFR)
angiotensin-converting enzyme inhibitors effects on,
241t, 243, 245
calcineurin inhibitors effects on, 361
calcium channel blockers effects on, 277
diabetes mellitus impact on, 409
diuretics effect on, 224f, 225
in African Americans
renal injury mechanisms affecting, 472–474, 473f
with prematurity, 472
in chronic kidney disease, 185, 357
blood pressure goals related to, 352, 352f
estimated, 186, 186t
staging based on, 351, 352t
in resistant hypertension, 502, 504, 509
uric acid correlation with, 35
Glomeruli
dyslipidemia impact on, 419
in African Americans
pressure-related injury to, 472–474, 473f
with prematurity, 472
Glomerulonephritis, chronic, in adolescents, 446
Glomerulosclerosis
focal segmental, in adolescents, 446
in chronic kidney disease, 186
Glucocorticoid-remediable aldosteronism (GRA)
hypertension secondary to, 115–116, 116f
pathophysiology of, 17t, 26f, 27t, 28f
Glucocorticoids
adrenalectomy indications for, 115, 128, 129
excess of. See Cushing’s syndrome.
for glucocorticoid-remediable aldosteronism, 116
hypertension related to
exogenous, 145, 148
in Cushing’s syndrome, 148–149, 503
resistance pathology, 106, 108, 501t, 503
in aldosterone biology, 26f, 40, 40f
synthesis pathway of, 108f
transplant hypertension and, 362
Glucose intolerance
diuretic-induced, 226
in children and adolescents, 447, 448
in diabetes mellitus, 406. See also Diabetes mellitus
(DM).
in metabolic syndrome, therapy indications based
on, 422, 422t
NAVIGATOR study on, 414
Glucose metabolism
α-adrenergic blockers effects on, 291
β-blocker promotion of, 236, 406
postoperative, with pheochromocytoma resection, 128
Goal orientation, for disease management programs,
531–532, 533
Goldblatt model, of renovascular hypertension, 94–95
Gordon’s syndrome, 17t, 27t
Gout, diuretic-induced, 224f, 226
GRA (glucocorticoid-remediable aldosteronism)
hypertension secondary to, 115–116, 116f
pathophysiology of, 17t, 26f, 27t, 28f
Grade 1 hypertension
CHEP 6 guidelines for, 561, 562t, 565f
evolving classifications for, 53–54, 54t
sequelae importance of, 10–11, 11f
Grade 2 hypertension
CHEP 6 guidelines for, 561, 563t, 565f
evolving classifications for, 53–54, 54t
Grade 3 hypertension
CHEP 6 guidelines for, 561, 563t, 565f
evolving classifications for, 53–54, 54t
Grafts, organ. See Transplant hypertension.
Great Britain
clinical practice guidelines of, 575, 575t
South Asian populations in, 495–496
594 Index
Growth factor-β, transforming, in African Americans,
469t, 471
Growth factors, vascular remodeling and, 38, 38f
Growth hormone (GH), chronic hypersecretion of, 150
Growth hormone-releasing hormone,
pheochromocytoma-related secretion of, 119
GSMA (genome search meta-analysis), 18
Guanabenz, for hypertension, 297f, 298t
Guanfacine, for hypertension, 297f, 298t
Gynecomastia, diuretic-induced, 227
Habitual snoring, 134, 135, 135t, 136, 139
in pregnant women, 136
Hallucinations, β-adrenergic blockers and, 236
Haplotypes, association studies of, 18–20
HapMap, 18, 20
Hazard ratios
for cardiovascular disease, 8, 9f
in outcome studies, 307, 308, 308f, 309, 311
nonadherence impact on, 312, 312t
HBPM. See Home blood pressure monitoring (HBPM).
HCTZ. See Hydrochlorothiazide (HCTZ).
HDFP. See Hypertension Detection and Follow-up
Program (HDFP).
HDL-C. See High-density lipoprotein cholesterol
(HDL-C).
Headaches
angiotensin-converting enzyme inhibitor-induced,
249
angiotensin II receptor blockers and, 257
Health and Welfare Canada, 552
Health care providers/professionals
as dietary/lifestyle modification advocates, 208
blood pressure measurement training for, 59–60, 59f
for disease management, 527–533. See also Disease
management services.
practice guidelines for. See Clinical practice
guidelines (CPGs).
Health Employer Data and Information Set (HEDIS),
527, 531, 566
Health insurance, for Hispanics, 485
Health Insurance Portability and Accountability Act
(HIPAA), 529
Health policies and procedures, evidence-based, 552
Health Professional Follow-up Study, 206
Healthy People 2000, 527
Healthy People 2010, 527
Heart and Estrogen/Progestin Replacement Study
(HERS), 464, 465
Heart Attack Primary Prevention in Hypertension
Research Group, 219
Heart block, β-blocker cautions with, 236
Heart disease/disorders. See also Cardiovascular disease
(CVD).
coronary. See Coronary heart disease (CHD).
ischemic. See Ischemic heart disease (IHD).
spectrum of, 178, 179t. See also specific disorder.
Heart failure (HF), 340–348
angiotensin-converting enzyme inhibitors for, 239,
240, 240t, 241, 242
end-organ effects and, 246–247
angiotensin II receptor blockers for, 259f, 261–262
assessment of, 179t, 181
β-adrenergic blocker cautions with, 236
calcium channel blockers and, 271, 281
characteristics of, 340
classification and staging of, 342, 342f
treatment based on, 343
coronary artery disease and, 341
demographics of, 181
diabetes mellitus and, 407, 408f
diastolic dysfunction with, 179t, 181
aging impact on, 340–341
diuretics for, 213, 214t, 216, 225
clinical trials on, 218–219, 220f–221f
epidemiology of, 340
heart transplantation for, 346–348
candidates for, 346
complications of, 347–348
exclusion criteria for, 346–347, 347t
physiology of, 347
survival with, 347, 348
hypertension risk for, 7, 8f
Heart failure (HF) (Continued)
historical perspective of, 58
in older individuals, 13, 13t, 340–341
hypertension treatment with, 342–348
CHEP 6 guidelines for, 564t
JNC 7 guidelines on, 555, 556t
WGTF 4 guidelines for, 558
hypertensive emergency with, 517, 518, 518t
management of, 519
in African Americans, 469
in elderly patients, 457, 459, 459t
in untreated hypertension, 162–163
left- vs. right-sided, 340–341
meta-analyses of, 317, 319t
active regimens and controls, 318, 320f
angiotensin receptor blockers, 322, 322f
blood pressure and risk, 323, 323f
different active regimens, 318, 321f
mortality with, 13, 13t, 340, 341
outcome studies on, 307
pathogenesis of, 181
pathophysiology of, 340–341
perioperative hypertension and, 512, 513t
management of, 514–515, 515f
peripartum, preeclampsia and, 436
prevention of, 341–342
sodium intake and, 203
surgical treatments for, 345–348
heart transplantation as, 346–348, 347t
mitral valve procedures, 345–346
ventricular assist devices, 346
systolic dysfunction with, 181
aging impact on, 340–341
treatment of, 342–348
treatment of, 342–348
blood pressure targets for, 342
electrical therapy for, 344–345
for stage A, 342
for stage B, 342
for stage C, 342
for stage D, 342
goals for, 342
specific drugs for, 343–344, 343f–344f
surgical procedures for, 345–348
ventricular failure in, 181
“Heart level,” for blood pressure cuff placement, 62
Heart Outcomes Prevention Evaluation trial (HOPE),
159, 159f, 162, 319t
diabetic patients in, 408, 409, 410, 411t, 414
on angiotensin-converting enzyme inhibitors, 239,
243, 244, 248, 389
secondary stroke prevention in, 398, 398f
Heart Protection Study (HPS), 421
Heart rate (HR)
age influence on, 72
circadian variations of, 89, 90
heart transplant and, 347
in perioperative hypertension, control of, 514, 515f
new drug development and, 540
sleep apnea impact on, 136, 137f
CPAP application and, 140, 141f
sleep physiology and, 134
sympathetic nervous system regulation of, 31f
Heart transplantation, hypertension related to, 361
Heavy metals, hypertension related to, 147–148
HEDIS (Health Employer Data and Information Set),
527, 531, 566
Height percentiles, for children, blood pressure levels
for, 440, 442t–445t
HELLP syndrome, in preeclampsia, 429, 435, 436, 437
Hematocrit, r-HuEPO impact on, 147
Hematology system, obstructive sleep apnea syndrome
findings in, 135, 136t
Hemiparesis
ataxic, 183
pure motor, 183
Hemodialysis patients. See also End-stage renal disease
(ESRD).
r-HuEPO risks for, 147
Hemodynamic monitoring, intraoperative, for
pheochromocytoma resection, 128
Hemodynamics
acromegaly impact on, 150
angiotensin-converting enzyme inhibitors effects on,
241–242, 241t, 243
Hemodynamics (Continued)
post-myocardial infarction, 239, 240, 240t, 242,
243, 247
β-adrenergic blockers effects on, 234
calcium channel blockers effects on, 269–270
diuretics effect on, 217–218, 217f
heart transplant and, 347
in African Americans, 469–470, 469t
obesity and, 371f, 372
of isolated systolic hypertension, 169, 170f, 171
preeclampsia and, 436
r-HuEPO impact on, 147
sleep apnea impact on, 136–138, 137f–138f
prognostic consequences of, 139, 139f
sympathetic nervous system regulation of, 31, 31f
transplant hypertension and, 361, 362
Hemolytic anemia, 518
Hemorrhage
intracerebral
acute, 183
fetal, with pregnancy-related hypertension, 431
hypertensive emergency with, 517, 518, 518t, 521
stroke related to, 392, 393, 393f, 399
intraretinal, in hypertensive retinopathy, 184, 185t
subarachnoid, 392, 393–394, 393f
hypertensive emergency with, 517, 518, 518t, 521
Hemorrhagic stroke, 160, 392–394, 393f, 398, 399, 400
hypertensive emergencies with, 517, 518, 518t
management of, 521
Hepatic 3-methylglutaryl–coenzyme A reductase
inhibitors, for stroke prevention, 400, 400t
antihypertensive drug interactions with, 420–421,
420t
Herbal therapy(ies)
for East Asian populations, 489
resistant hypertension related to, 508, 508t
Heritability, of hypertension, 6, 19, 22. See also Genetics.
“narrow sense,” 15–16
secondary, 119–122, 121t
HERS (Heart and Estrogen/Progestin Replacement
Study), 464, 465
HF. See Heart failure (HF).
HHS. See U.S. Department of Health and Human
Services.
High-density lipoprotein cholesterol (HDL-C)
α-adrenergic blockers effects on, 291
β-adrenergic blockers effect on, 236, 421
as risk factor, 7, 8f, 12, 418–419
treatment principles for, 423
global cardiovascular risk and, 190, 191f–192f, 196
historical studies on, 305
metabolic syndrome therapy and, 422
vascular wall impact of, 419
Hip fracture, related to α1-adrenoceptor antagonists,
292
HIPAA (Health Insurance Portability and
Accountability Act), 529
“Hispanic hypertension paradox,” 483
Hispanics
hypertension in, 482–485
acculturation role, 483
definition of, 482
detection disparities in, 468, 483–484, 483t, 484f
disease management models for, 529, 530
heterogeneity of populations and, 483, 485
mortality trends of, 161
prevalence trends, 4, 4t, 6, 482–483
sociodemographic factors of, 483, 484, 495
treatment of
disparities in, 483–484, 483t, 484f
evidence for optimal regimens, 484–485
sociocultural issues in, 485
under treatment of, 483–484, 483t, 484f
low birth weight in, 472
Historical control group, in new drug development,
540–542, 541f
History taking
for blood pressure measurement, 63
for heart failure assessment, 181
for hypertension diagnosis, 145
for hypertensive emergencies, 518
for mineralocorticoid excess states, 106, 116
HIV (human immunodeficiency virus) infection
antiviral agents for, hypertension related to, 148
composite outcome trials on, 310

HMG Co-A (hydroxymethylglutaryl–coenzyme A)
reductase inhibitors, 539, 545
Home blood pressure monitoring (HBPM), 69–82
acceptability to patients, 71
advantages of, 69, 70t
age influence on, 72
alcohol influence on, 73, 73t
blood pressure classifications and, 53–54
by elderly patients, 458
by family members, 71
caffeine influence on, 73, 73t
cardiovascular event prediction and, 77
clinic pressures vs., 74–76
comparisons of, 74–75, 74f
correlations between, 76, 76t
in clinical trials, 80–81, 80t
white-coat effect and, 75, 77–78
cost-effectiveness of, 81, 81t
day of week influence on, 72, 73, 73t
demographic factors of, 72
environmental factors of, 72–74, 73t, 77
equipment choice for, 70, 71f
equipment testing for, 69–70, 70t
exercise influence on, 73t, 74
for antihypertensive treatment evaluation
ambulatory monitoring and, 88
evidence of improvement, 80
in clinical practice, 78–80
in clinical trials, 80–81, 80t
intensity of treatment guidance, 80
minimum number of readings, 79, 79f
of time course, 80
of trough-to-peak ratio, 72, 80
optimal treatment identification, 79, 79f
placebo effect immunity, 80, 80t
sample size advantage, 81
target organ damage correlation, 76–77, 80
validity of, 78–79, 78f–79f
for hypertension diagnosis, 77–78, 78f
for transplant hypertension, 363
frequency recommendations for, 72, 532
future trends of, 81–82, 81f
gender influence on, 72
guidelines for
CHEP 6, 561
international comparisons of, 571, 572t
JNC 7, 555
in children, 76
in normotensive subjects, 74
limitations of, 69, 70t, 77
meals influence on, 73, 73t
normal limits of, population studies of, 74, 76, 76t
overview of, 69, 82
practical issues of, 71–72
reporting accuracy in, 71
reproducibility of, 71–72
seasonal influence on, 73, 73t
smoking influence on, 73, 73t
stress influence on, 73–74, 73t, 77
sustained hypertension diagnosis with, 77–78, 78f
talking influence on, 73, 73t
target organ damage and, 76–77, 80
technical problems of, 144
time of day influence on, 72, 73, 73t, 77
24-hour ambulatory monitoring vs., 69, 77
correlations between, 75–76
white-coat effect and
clinic monitoring vs., 75, 75f
elimination of, 69, 70t, 77
white-coat hypertension diagnosis with, 75, 77–78
HOMOG study, 221f
Honolulu Heart Study, 488
HOPE. See Heart Outcomes Prevention Evaluation trial
(HOPE).
Hormone replacement therapy (HRT)
hypertension related to, 145
in elderly patients, 458, 464–465, 465t
Hormones
disturbances of
hypertension related to, 148–150
obesity and, 371–372, 371f
sex
adrenocortical enzyme deficiency impact on,
106–108, 108f
hypertension related to, 145
HOT. See Hypertension Optimal Treatment (HOT) trial.
HPS (Heart Protection Study), 421
HR. See Heart rate (HR).
HRT (hormone replacement therapy), in elderly
patients, 458, 464–465, 465t
HSCSG (Hypertension-Stroke Cooperative Study
Group), 161, 161f
Human genome
hypertension research related to. See Genetics.
structural property of, 16, 18
variations in, 16
Human immunodeficiency virus (HIV) infection
antiviral agents for, hypertension related to, 148
composite outcome trials on, 310
Humoral rejection, in heart transplant, 347–348
Hydralazine hydrochloride
for diabetes-related hypertension, 413
for hypertension
in African Americans, 475, 476
in children and adolescents, 450, 453t
for preeclampsia, 436, 437t
for pregnancy-related hypertension, 433t, 434
for resistant hypertension, 505f, 506
historical studies on, 305
intravenous
for children and adolescents, 450, 454t
for hypertensive emergencies, 519, 521–522, 521t
Hydration therapy, for preeclampsia, 436
Hydrochlorothiazide (HCTZ)
adverse effects of, 224, 227
ambulatory blood pressure monitoring for, 90
angiotensin II receptor blockers combined with, 256,
258, 259, 261
calcium channel blockers vs., 272t
for diabetes-related hypertension, 411t, 412
for heart failure, 343
for hypertension, 29, 218, 222, 223
in African Americans, 476
in children and adolescents, 450, 452t
in East Asian populations, 489
in elderly patients, 462t
in Hispanics, 484–485
for obesity-related hypertension, 378, 379
for pregnancy-related hypertension, 433t, 434
for primary aldosteronism, 114, 114f
for renal arteriopathy, 33
for transplant hypertension, 365t, 366
historical studies on, 305
outcome studies on, 307, 309, 310
pharmacokinetics of, 214t, 215
regulatory development of, 542, 545
Hydrogen, diuretic therapy impact on, 213, 214f, 224f
18-Hydroxycorticosterone, in primary aldosterone,
112–113, 114f
18-Hydroxycortisol, in glucocorticoid-remediable
aldosteronism, 115–116, 116f
11β-Hydroxylase, in glucocorticoid-remediable
aldosteronism, 115–116, 116f
11β-Hydroxylase deficiency, hypertension related to, 6,
107
17α-Hydroxylase deficiency, hypertension related to, 6,
107–108
Hydroxymethylglutaryl–coenzyme A (HMG Co-A)
reductase inhibitors, 539, 545
11β-Hydroxysteroid dehydrogenase deficiency, 108–109,
109f
5-Hydroxytryptamine-1A agonists, new investigations
on, 298
Hypercalcemia, resistant hypertension related to, 500f,
501t, 504
Hypercapnia, obstructive sleep apnea syndrome and,
136, 137
Hypercholesterolemia. See also Dyslipidemia.
as risk factor, 7, 8f, 12
inherited, 29
familial, peripheral artery disease associated with,
384
Hypercoagulability, in metabolic syndrome, therapy
indications based on, 422, 422t
Hypercortisolism, in Cushing’s syndrome, 109–110,
148–149
screening for, 149
Hyperglycemia
diuretic-induced, 226
in diabetes mellitus, 406
Index 595
Hypergonadism, with adrenocortical enzyme deficiency,
107
Hypergonadotropic hypogonadism, with adrenocortical
enzyme deficiency, 107–108
Hyperinsulinemia
acromegaly associated with, 150
dyslipidemia and, 418–419, 419t
in diabetes mellitus, 408, 409f
obesity and, 371, 371f
Hyperkalemia
angiotensin-converting enzyme inhibitors and, 246, 249
angiotensin II receptor blockers causing, 264
diuretic-induced, 223–225, 224f
transplant hypertension and, 365
Hyperlipidemia, diuretic-induced, 226–227
Hyperparathyroidism
hypertension related to, 150
resistant hypertension related to, 500f, 501t, 504
Hyperplasia
adrenal. See Adrenal hyperplasia.
aldosterone-producing adenoma vs., 112–113, 148, 149
benign prostatic, α1-adrenoceptor antagonists and,
286, 288, 291
of pituitary gland, secondary, 150
Hypertension. See also specific type, e.g. White-coat
hypertension.
accelerated, 165. See also Malignant hypertension.
chronic. See Chronic hypertension.
coarctation of the aorta and, 148
definition of, 49–55
age as consideration in, 49–50, 50f
antihypertensive drug therapy goals and, 51–52
cardiovascular disease risk and, 50–51, 51f–52f
clinical approach to, 51–52
epidemiologic approach to, 50–51
evolving classifications in, 52–54, 53f, 54t
for select patient groups, 54–55
historical perspective of, 49, 58
overview of, 3, 49
target recommendation perspectives, 55
diagnosis of. See Diagnosis.
diet and, 201–209. See also Diet.
disease management of, 527–533. See also Disease
management services.
epidemiology of, 3–5, 217. See also Epidemiology.
essential
developmental phases of, 34
in children and adolescents, 446–447
characteristic findings of, 448
renal microvascular disease and, 34–35, 35f
genetics of, 15–23. See also Genetics.
global cardiovascular risk and, 190–191, 191f, 196
hormonal disturbances causing, 148–150
iatrogenic causes of, 145–148
in adolescents, 49–50, 50f, 54. See also Adolescents.
in children, 49–50, 50f, 54, 440. See also Children.
acute, 446, 446t
in older individuals, 12–13, 13t. See also Elderly
patients.
in perioperative period, 512–515. See also
Perioperative hypertension.
in pregnancy, 429–438. See also Pregnancy.
incidence of, 3
obstructive sleep apnea syndrome association with,
135–136, 136t. See also Obstructive sleep
apnea syndrome.
pathophysiology of, 25–43. See also Pathophysiology.
post-transplant, 361–367. See also Transplant
hypertension.
prevalence of, 3–5, 217
rare and unusual causes of, 145–150
refractory, 498–509. See also Resistant hypertension.
risk factors for, 5–6. See also Risk factors.
risk stratification for, 153, 155–196. See also Risk
stratification.
secondary. See also Secondary hypertension.
in African Americans, 469
in pregnancy, 430, 437, 438f
mineralocorticoid excess and, 106–116. See also
Mineralocorticoid excess states.
pheochromocytoma in, 119–130. See also
Pheochromocytoma.
renovascular, 93–103. See also Renovascular
hypertension.
sleep apnea and, 134–141. See also Sleep apnea.
596 Index
Hypertension (Continued)
sequelae and outcomes with, 7–12. See also Sequelae.
staging of
CHEP 6 guidelines for, 561, 562t–563t, 565f
definition of, 6–7, 7t
evolution of, 53–54, 54t
in children, 440
in elderly patients, 457, 463
JNC 7 guidelines for, 554t, 555, 566
WGTF 4 guidelines for, 558, 559t, 560f, 561
WHO endorsements for, 53, 171, 496, 561, 566
undertreatment of, 517
untreated. See also Untreated hypertension.
adverse events with, 157–164, 517
emergencies related to, 517–523. See also
Hypertensive emergency(ies).
natural history of, 155–157, 156f, 166
subclinical target organ damage with, 164–165
urgencies related to, 517–518
management of, 522
Hypertension Control Program, obesity and, 375
Hypertension Detection and Follow-up Program
(HDFP), 51–52
elderly patients in, 459t
lessons learned from, 305
on diuretics, 222, 226, 227
on heart disease, 159, 159f, 162f
on renal disease, 164
on stroke, 161f
Hypertension in the Very Elderly Trial (HYVET), 459t,
464
pilot study of, 464
Hypertension Optimal Treatment (HOT) trial, 52, 55,
273, 276t, 319t, 334
chronic kidney disease in, 352–353, 354f
diabetic patients in, 407, 408f
elderly patients in, 462
home vs. clinic blood pressure monitoring in,
74–75
resistant hypertension in, 498, 505
Hypertension-Stroke Cooperative Study Group
(HSCSG), 161, 161f
Hypertension Study Group, screening criteria
recommendations, 53
Hypertensive crises
acute
with malignant pheochromocytoma, 129
with pheochromocytoma resection, 128
prevention of, 126–128
adrenergic blockers for, 236
r-HuEPO risks for, 147
triple-drug antiviral therapy causing, 148
Hypertensive emergency(ies), 517–523
acute coronary syndromes and, 517, 518, 518t
management of, 519
aortic dissection and, 517, 518, 518t, 519
management of, 519
catecholamine crisis in, 522
clinical situations presenting as, 517, 518t
definition of, 517
eclampsia and, 517, 518, 518t
management of, 522
encephalopathy and, 517, 518, 518t
in children, 561
management of, 522
evaluation of, 518
heart failure and, 517, 518, 518t
management of, 519
hemorrhagic stroke and, 517, 518, 518t
management of, 521
ischemic stroke and, 517, 518, 518t, 519
management of, 521
management of, 518–522
diagnostic verification for, 518, 519f
for special situations, 519, 521–522
in children and adolescents, 450, 454t
parenteral drugs for, 517, 519, 520t–521t
primary goal for, 519
miscellaneous situations causing, 522
perioperative, 522
pulmonary edema and, 517, 518, 518t
management of, 519, 521
risk factors for, 517
triage of, 518, 519f
urgencies vs., 517–518
Hypertensive retinopathy
assessment of, 184–185, 185t
Keith-Wagener-Barker classification of, 157
natural history of, 156f, 157, 165
Hypertensive urgency(ies), 517
emergencies vs., 517–518
management of, 522
in children and adolescents, 450, 454t
Hyperthyroidism
hypertension related to, 149
resistant hypertension related to, 501t, 503
Hyperuricemia
as risk factor, 35–36
diuretic-induced, 224f, 226
essential hypertension role of, 34, 35f
transplant hypertension and, 365
Hyperventilation, obstructive sleep apnea syndrome
and, 137, 137f
Hypocaloric diet, for weight loss, 372, 373t, 377t
Hypoglycemia
β-blocker promotion of, 236, 406
postoperative, with pheochromocytoma resection,
128
Hypogonadism, hypergonadotropic, with
adrenocortical enzyme deficiency, 107–108
Hypokalemia
aldosterone role in, 40, 108
CHEP 6 guidelines for, 564, 565
diuretic-induced, 223–225, 224f
in primary aldosteronism, 110, 111f–112f, 112t, 113t
diagnostic applications of, 113, 114f
therapeutic considerations, 114–115, 115f
with mineralocorticoid excess states, 106, 107f, 107t,
108
Hypokalemic alkalosis, in ectopic ACTH syndrome,
109–110
Hypomagnesium, diuretic-induced, 213, 225–226
Hyponatremia, diuretic-induced, 223, 224f
Hypotension
angiotensin-converting enzyme inhibitor-induced,
249
in perioperative hypertension, 514
nocturnal
acromegaly impact on, 150
attenuated, in African Americans, 478–479
Binswanger’s lesions from, 165
in elderly patients, 462–463
orthostatic
diabetes-related hypertension and, 413
with α1-adrenoceptor antagonists, 292
postoperative, with pheochromocytoma resection, 128
postural
angiotensin-converting enzyme inhibitors and,
242
in elderly patients, 458, 463
Hypothalamus, sympathetic activity modulation by,
31–32, 32f
Hypothesis testing, in outcome studies, 311, 311f
Hypothyroidism
hypertension related to, 149
resistant hypertension related to, 501t, 503
Hypovolemia, transplant hypertension and, 364
Hypoxemia, obstructive sleep apnea syndrome and, 136,
137
Hypoxia
endothelial dysfunction induced by, 138
sympathetic nervous system response to, 32
HYVET (Hypertension in the Very Elderly Trial), 459t,
464
pilot study of, 464
123
I-MIBG (iodine-123-meta-iodobenzylguanidine)
scintigraphy, for pheochromocytoma
localization, 124f, 125–126, 126f
malignant, 129
131
I-MIBG (iodine-131-meta-iodobenzylguanidine)
therapy, for malignant pheochromocytoma,
129
I-PRESERVE (Irbesartan in Heart Failure with
Preserved Systolic Function), 263
Iatrogenic causes, of hypertension, 145–148
Ibopamine, 296
IC. See Intermittent claudication (IC).
ICD (International Classification of Disease), for meta-
analyses outcomes, 317
ICH (International Conference of Harmonization), 538,
541, 542, 545
ID genotype, of angiotensin-converting enzymes, 246
IDH. See Isolated diastolic hypertension (IDH).
IDNT. See Irbesartan Diabetes Nephropathy Trial
(IDNT).
IGF-I (insulin growth factor-I), in acromegaly, 150
IHD. See Ischemic heart disease (IHD).
II genotype, of angiotensin-converting enzymes, 246
IL-6 (interleukin 6), candidate genes of, 19t
Iliac arteries
peripheral artery disease in, 385
stenosis of, transplant hypertension and, 364
Illicit drugs
adolescents use of, 446, 446t
resistant hypertension related to, 500f, 507, 508t
Imaging studies
for adrenal adenoma localization, 113, 149
for arterial assessment, 182
for chronic kidney disease, 186
for coarctation of the aorta, 148
for ischemic heart disease assessment, 180
for pheochromocytoma localization, 119, 121f, 122,
124f–127f, 125
postoperative follow-up, 129
for stroke assessment, 183–184
in left ventricular hypertrophy assessment, 179t, 180
Imidazoline agonists, central
new investigations on, 297–298
properties of, 298t
side effects of, 297
targets of, 297f
Imidazoline-I receptors, 297, 297f
Immune system, candidate genes of, 19, 19t
Immunosuppressive agents
for organ transplantation, 361
corticosteroid effects, 362
malignancy risk with, 348
regimen modifications of, 366–367
hypertension related to, 146
Impotence
α1-adrenoceptor antagonists for, 291–292
diuretic-induced, 227
drug therapy for, hypertension related to, 145
IMT (intima-media thickness), calcium channel
blockers effect on, 278–279
Incidence, of hypertension, 3
Incontinence, α1-adrenoceptor antagonists causing, 292
Indapamide, 226, 247
for East Asian populations, 490
for stroke prevention, secondary, 398
for transplant hypertension, 365t, 366
for vascular dementia, 402
Indian Consensus Groups, 494
Indians, American. See Native Americans.
Indians, Asian, hypertension in
prevalence studies of, 493–494, 494t
recent, 494–495, 495t
urban vs. rural, 495, 495t, 496
risk factors for, 495
staging of, 496
treatment considerations for, 496
Indomethacin, diuretics interaction with, 227
INDs. See Investigational new drugs (INDs).
Industry sponsors, representation in education
program, 553t
Infants, hypertension in, 440, 446
Infarction
cardiac embolic, 183
cerebral, 183
hypertensive emergency with, 517, 518, 518t, 519
management of, 521
lacunar, 183, 184
myocardial. See Myocardial infarction (MI).
Infection, heart transplant and, 347
Inferior petrosal sinus procedure, for ACTH
concentration, 110
Inflammation
candidate genes of, 19t
coronary heart disease and, 194
essential hypertension related to, 34, 35f
in diabetes mellitus, 408–409, 409f
markers of, 138

Inflammation (Continued)
obstructive sleep apnea syndrome and, 138, 138f
vascular remodeling and, 38, 38f
with dyslipidemia, and hypertension, 419, 422, 422t
Informed consent, for clinical trials, 313
Innominate arteries, assessment of, 182
Inotropy, sympathetic nervous system activity and, 29
INSIGHT (International Nifedipine GITS Study), 221f,
272t, 273, 274t, 275, 276t, 277–280, 278t, 319t
elderly patients in, 459
Insomnia, β-adrenergic blockers and, 236
Institute of Medicine
potassium intake guidelines of, 204
sodium intake guidelines of, 203
Institutional Review Boards (IRBs)
for clinical trials, 312, 313
new drug development role, 536–537
Institutions, representation in education program, 552,
553, 553t
Insulin, diuretics effect on, 226
Insulin-dependent diabetes mellitus. See Type 1 diabetes
mellitus.
Insulin growth factor-I (IGF-I), in acromegaly, 150
Insulin resistance
as risk factor, 12
inherited, 29
mechanisms of, 406, 407t
coronary heart disease and, 195, 327
dyslipidemia and, 418, 419t
microalbuminuria associated with, 419
therapy indications based on, 422, 422t
in diabetes-related hypertension, 406, 408–409, 409f,
414
in East Asians, 488
obesity and, 371, 371f, 378
obstructive sleep apnea syndrome and, 138
Insulin sensitivity, antihypertension agents effect on,
244, 256, 414
Insurance coverage, for Hispanics, 485
INTACT (International Nifedipine Trial on
Antiatherosclerotic Therapy), 279
Intensive medical therapy (MED), for left ventricle
restoration, 346
Interdosing interval, 542
Interfering exogenous substances, resistant
hypertension related to, 500f, 507–508, 508t
Interindividual variability, in blood pressure
measurement, 59, 59f
Interleukin 6 (IL-6), candidate genes of, 19t
Intermittent claudication (IC), 384. See also Peripheral
arterial disease (PAD).
hypertension contributing to, 385
International Classification of Disease (ICD), for meta-
analyses outcomes, 317
International Clinical Epidemiology Network Study,
495
International Conference of Harmonization (ICH), 538,
541, 542, 545
International Nifedipine GITS Study (INSIGHT), 221f,
272t, 273, 274t, 275, 276t, 277–280, 278t, 319t
elderly patients in, 459
International Nifedipine Trial on Antiatherosclerotic
Therapy (INTACT), 279
International Prospective Primary Prevention Study in
Hypertension, 219
International Protocol, for ambulatory monitoring
devices, 91
International Society of Hypertension (ISH)
classification endorsements of, 53, 55, 171, 561
guidelines of, European and American guidelines vs.,
571–574
on observational studies, 271
International Stroke Trial, 399
International Study on Macronutrients, 206
International trends. See also Global epidemiology.
in hypertension, 4–5
International Verapamil-Trandolapril (INVEST) study,
271, 272t, 273, 274t, 275, 276t, 280, 281
chronic kidney disease in, 354t
diabetic patients in, 411t, 414
resistant hypertension in, 498
stroke in, 396
INTERSALT study, 202f, 222
Intervention as a Goal in Hypertension Treatment,
221f
Intestines, angioedema of, angiotensin-converting
enzyme inhibitor-induced, 249, 250f
Intima-media thickness (IMT), calcium channel
blockers effect on, 278–279
Intra-arterial blood pressure, recordings of, 85
cuff measurements vs., 144, 172
Intra-aortic renal angiography, for renovascular
hypertension, 100
Intracerebral aneurysm, 160
Intracerebral arteries, occlusion of, stroke related to,
392, 393, 393f
Intracerebral hemorrhage
acute, 183
fetal, with pregnancy-related hypertension, 431
hypertensive emergency with, 517, 518, 518t
management of, 521
stroke related to, 392, 393, 393f, 399
Intrauterine growth restriction, pregnancy-related
hypertension and, 431
Intrauterine life, transition to extrauterine life, 440
Intravascular volume. See also Plasma volume (PV).
in African Americans, 469t, 470
therapeutic limitation of, 478, 478f
Intravenous digital subtraction renal angiography, for
renovascular hypertension, 100
Intravenous (IV) drugs, for hypertensive emergencies,
519, 520t–521t
in children and adolescents, 450, 454t
Intravenous (IV) fluids, for preeclampsia, 436
Intravenous pyelogram, rapid-sequence, for
renovascular hypertension, 98
Intrinsic sympathomimetic activity, β-adrenergic
blockers effect on, 231, 232t, 236
INVEST. See International Verapamil-Trandolapril
(INVEST) study.
Investigational new drugs (INDs), 295–300
aldosterone antagonists as, 295–296
application for, 535, 536
dopamine-1 receptor agonists as, 296
dopamine-2 receptor agonists as, peripheral, 296
endocannabinoid-1 receptor antagonists as, 300
endopeptidase inhibitors as, neutral, 298–299,
299f
endothelin antagonists as, 296–297
5-hydroxytryptamine-1A agonists as, 298
imidazoline agonists, central, 297–298, 297f, 298t
overview of, 295, 300
potassium channel openers as, 299
regulatory perspectives of, 535–546. See also
Regulatory development.
renin inhibitors as, 299–300, 300f
review period for, 537–538
serotonin agonists as, 298
Iodine-121 hippurate scan, for renovascular
hypertension, 98
Iodine-123-meta-iodobenzylguanidine (123I-MIBG)
scintigraphy, for pheochromocytoma
localization, 124f, 125–126, 126f
malignant, 129
Iodine-131-meta-iodobenzylguanidine (131I-MIBG)
therapy, for malignant pheochromocytoma,
129
Ion channels, epithelial
candidate genes of, 19, 19t
pharmacogenetic studies of, 20–21
Irbesartan
clinical outcome studies on, 272t
for children and adolescents, 450, 451t
for diabetes-related hypertension, 412
for transplant hypertension, 365t, 366
pharmacologic properties of, 255t, 256
Irbesartan Diabetes Nephropathy Trial (IDNT), 159f,
162, 162f, 319t, 322
chronic kidney disease in, 353t, 354, 354f, 356,
357
outcome-based results of, 258, 259f, 260, 272t,
412
Irbesartan in Heart Failure with Preserved Systolic
Function (I-PRESERVE), 263
Irbesartan Microalbuminuria for Type 2 Diabetes
Mellitus in Hypertensive Patients (IRMA-2)
trial, 257–258, 354–355, 412
IRBs (Institutional Review Boards)
for clinical trials, 312, 313
new drug development role, 536–537
Index 597
IRMA-2 (Irbesartan Microalbuminuria for Type 2
Diabetes Mellitus in Hypertensive Patients)
trial, 257–258, 354–355, 412
Irradiation. See Radiation therapy.
Ischemia
chronotherapy for
assessing effects of, 89–90, 90t
delivery systems impact on, 90
essential hypertension role of, 34, 35f
perioperative hypertension and, 512, 513, 513t
management of, 514–515, 515f
Ischemic heart disease (IHD), 327–337
angiotensin-converting enzyme inhibitors for, 243
assessment of, 179t, 180
β-blocker cautions with, 236
blood pressure lowering parameters for, 333–334
hypertension relationship with, 327–328, 328f
defining, 51, 51f
management of, 334–335
primary prevention of, 328–334
with acute coronary syndromes, 336–337
in untreated hypertension, 156, 157–159, 158f–159f
risk factors for, 327, 328t
Ischemic nephropathy, renovascular hypertension with,
94
Ischemic spots, in hypertensive retinopathy, 184, 185
Ischemic stroke, 160, 392, 394, 399, 400, 401
hypertensive emergency with, 517, 518, 518t, 519
management of, 517, 518, 518t, 519
ISH. See International Society of Hypertension (ISH);
Isolated systolic hypertension (ISH).
Isolated diastolic hypertension (IDH)
age factor of, 169, 170f
home monitoring and, 77
in Native Hawaiians, 488
pathophysiology of, 169, 170f
prehypertension risk for, 166
Isolated systolic hypertension (ISH), 169–175
antihypertensive drug selection for, 174
antihypertensive drug therapy for
benefits of, 173
selection of, 174
target goals for, 173–175
arterial stiffness etiology in, 171–172
average diastolic blood pressure reached prior to,
171, 171f
calcium channel blockers for, 281
cardiovascular risk with, 169–170, 170f
diagnostic caveats in, 172–173
co-morbidities of, 169
coronary heart disease risk and, 171, 171f
definition of, 169
epidemiology of, 169
hemodynamics of, 169, 170f, 171
in elderly patients
cardiovascular disease risk and, 457–458
pathophysiology of, 457
pharmacologic treatment of, 460–461, 460t
goals of, 461–463, 462t
prevalence of, 457
in Native Hawaiians, 488
pathophysiology of, 173, 328
prehypertension risk for, 166
pulse pressure and, 169–170, 170f
resistant, in elderly, 499t, 507, 509
therapeutic benefits for, 173
therapeutic target goals for, 173–174
factors of achieving, 174–175
treatment guidelines for
CHEP 6, 561, 565
international comparisons of, 572–574, 572f, 572t,
573t, 575t
underestimation of, 172
wave reflection and, 172
Isoproterenol, molecular structure of, 232, 235f
Isosorbide dinitrate
for peripheral arterial disease, 389
for pregnancy-related hypertension, 434
Isradipine
clinical outcome studies on, 272t, 276t
for children and adolescents, 450, 452t
intravenous, 450, 454t
for East Asian populations, 489
for transplant hypertension, 365t, 366
IV. See Intravenous entries.
598 Index
J-curve hypothesis, in antihypertensive drug trials,
55, 334
elderly patients and, 462
Janeway, Theodore Caldwell, 156
Japan Multicenter Investigation for Cardiovascular
Disease-B (JMIC-B), 272t, 319t
Japanese populations, hypertension in
prevalence of, 487–488, 488t
stroke risk with, 394, 395f
treatment of
considerations for, 488–489
outcome studies of, 487, 489–490
side effects with, 487, 490
JMIC-B (Japan Multicenter Investigation for
Cardiovascular Disease-B), 272t, 319t
Joint National Committee (JNC), 552
Seventh Report of (JNC 7)
angiotensin-converting enzyme inhibitor
recommendations, 244
β-adrenergic blocker recommendations, 231
blood pressure goal recommendations, 7, 53,
173–174
for chronic kidney disease, 352–353, 354
target organ damage and, 178
blood pressure measurement recommendations
for home monitoring, 69, 76
in office, 59
blood pressure staging system of, 6–7, 7t, 566
clinical practice guidelines in
British guidelines vs., 575, 575t
European guidelines vs., 571–575
differences, 572–575, 573t
major agreements, 571, 572f, 572t
on first-choice drugs, 573–574, 574f–575f
on prehypertension, 572
on total cardiovascular risk, 573
on treatment indications, 574
other issues in, 574–575
for adults, 553–557, 554t, 556t, 557f
WGTF 4 guidelines vs., 558–561, 559t, 560f
Fifth Report of vs., 169
history of, 552
hypertension definition guidelines of, 52–53, 53f
ethnic applications of, 488
evolving classifications for, 53–54, 54t, 55
on diuretic therapy, 213, 217
on exercise for weight loss, 376
on hypertensive urgencies, 517
on lifestyle modifications, 409
for elderly patients, 459, 459t
on obstructive sleep apnea syndrome, 141
on peripheral artery disease, 389
Sixth Report of vs., 572
K/DOQI (Kidney Disease Outcomes Quality Initiative)
Working Group, of NFK (National Kidney
Foundation), 352, 354, 355, 357
Kaiser Permanente of Colorado, 531, 532
Kaliuresis, in mineralocorticoid excess states, 111f–112f,
108, 110, 113
Kallidin, metabolism of, 37
Kallikrein-kinin system
in African Americans, 469t, 470, 471
mediating role of, 42–43
Keith-Wagener-Barker classification, of retinopathy,
157, 165
Ketamine hydrochloride, hypertension related to,
145
Ketanserin, 387, 434
Ketoconazole
for ACTH-producing tumors, 110
hypertension related to, 145
Keys score, cholesterol intake and, 206
Kidney(s). See also Renal entries.
chemoreceptors in, 30, 30f–32f
developmental defects of, angiotensin II receptor
blockers causing, 264
diuretics action in, 213, 214f
adaptation to, 216, 223, 224f
injury to, in African Americans
pressure-related mechanisms of, 173f, 472–474
with prematurity, 472
movement of, renovascular hypertension with, 94
Kidney disease, 351–358
angiotensin II receptor blockers for, 259f, 260
calcium channel blockers cautions with, 281
CHEP 6 guidelines for, 561, 564, 564t, 565
chronic. See Chronic kidney disease (CKD).
coronary heart disease and, 195
diet and, 201, 203, 207
end-stage. See End-stage renal disease (ESRD).
genetic mechanisms of, 25, 26f, 27, 28, 28f
home blood pressure monitoring and, 77
hypertension risk for, 3, 7, 12
in children and adolescents, 446, 446t, 448
hypertension treatment with, 357–358, 357t
goals for, 352–357
in resistant hypertension, 498
microvascular, 34–35, 35f
new drug development and, 539
pathophysiology of, 351–352, 352t
preeclampsia and, 431, 435, 436
prevalence of, 351, 352f
renovascular hypertension related to, 93–94
sympathetic nerve stimulation and, 32–33
uric acid stimulation of, 35–36
Kidney Disease Outcomes Quality Initiative (K/DOQI)
Working Group, of National Kidney
Foundation (NFK), 352, 354, 355, 357
Kidney function. See Renal function/dysfunction.
Kidney transplantation, hypertension related to, 361,
363, 366
Kinases
protein
cyclic guanosine monophosphate–dependent, 33, 34f
mitogen-activated, in angiotensin II–converting
enzyme mediation, 38–39, 38f
protein C, in α1-adrenoceptor activation, 287, 287f
Rho/Rho, vascular tone and, 33, 34, 34f
tyrosine
fms-like, in preeclampsia, 430t, 435
in angiotensin II–converting enzyme mediation,
38, 38f
vascular remodeling and, 38, 38f
Kininases, 42
Kinins, mediating role of, 42–43
Korean populations, hypertension in
prevalence of, 488, 488t
treatment of
considerations for, 488–489
outcome studies of, 487, 489–490
side effects with, 487, 490
Korotkoff, Nicolai S., 551
Korotkoff sounds
in blood pressure measurement, 60, 61, 144
ambulatory, 90
clinical guidelines for, 441, 554t, 558, 561
history of, 551
in children and adolescents, 441
knowledge assessment of, 66
listening to, 64
making louder, 64
temporary disappearance of, 63–64
in manometer calibration technique, 61
KR-30450, for hypertension, 299
Labeling claims, outcome, for new drugs, 543–544
Labetalol, 236
α1-adrenoceptor antagonist activity of, 288
breast milk concentrations of, 437
elimination characteristics of, 234t
for children and adolescents, 450, 451t
for peripheral arterial disease, 390
for preeclampsia, 436, 437t
for pregnancy-related hypertension, 433t, 434
for resistant hypertension, 505f, 506
intravenous
for children and adolescents, 450, 454t
for hypertensive emergencies, 519, 520t, 521–522
molecular structure of, 232, 235f
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
preoperative, for pheochromocytoma resection, 127
Laboratory studies
for angina assessment, 334
for children and adolescents, 560
Laboratory studies (Continued)
for elderly patients, 458
for hypertensive emergencies, 518
for mineralocorticoid excess states, 106, 107f
for pheochromocytoma, 119, 121f, 122, 123, 124f
for preeclampsia, 429, 430, 431, 431f, 435
for primary aldosteronism, 110, 111f–112f, 113t
Lacidipine, 272t, 276t
Lactation, antihypertensive drugs and, 437–438
Lacunar infarction, 183, 184
Lacunar stroke, 392, 393f
Language, as health care barrier, 485
Laparoscopic adrenalectomy, for pheochromocytoma,
128
Large arteries
calcium channel blockers effects on, 279–280
central, 181, 182
assessment of, 182
cerebral, infarction of, 183
LBW (low birth weight), in African Americans, 472
LD (linkage disequilibrium), 16, 18, 20
LDL-C. See Low-density lipoprotein cholesterol
(LDL-C).
Left ventricle, cardiac
ejection fraction of, in isolated systolic hypertension,
171, 173
mass of
β-adrenergic blockers effects on, 234
increased. See Left ventricular hypertrophy (LVH).
sleep apnea impact on, 139
Left ventricular assist device (LVAD), for heart failure,
346
Left ventricular function/dysfunction
aging impact on, 340–341
angiotensin-converting enzyme inhibitors for, 239,
240, 240t, 243
assessment of, 179t, 181
coronary artery disease and, 341
diabetes mellitus impact on, 413
hypertension impact on, 340–341
in heart failure, 340
pacing indications for, 345
surgical treatments for, 346
in untreated hypertension, 162–163
sleep apnea impact on, 139
with ST-segment elevation myocardial infarction,
336–337
Left ventricular hypertrophy (LVH)
angiotensin II receptor blockers effect on, 257,
260–261, 265
assessment of, 179–180, 179t
ambulatory blood pressure monitoring for, 87,
180
echocardiography for, 180
electrocardiography for, 179–180
other imaging techniques for, 180
overview of, 180
β-adrenergic blockers effects on, 234
calcium channel blockers effects on, 279
cardiac load and, 179
central systolic blood pressure and, 179
chronic sympathetic stimulation and, 32
concentric, 178–179, 179t, 180
coronary artery disease risk with, 327, 328t
coronary artery perfusion and, 333–334, 333f
demographic associations of, 178
diuretics for
adverse effects of, 224
regression with, 222–223
eccentric, 178–179, 179t
endothelial dysfunction and, 179
genetics of, 179
geometry of, 178–179
global cardiovascular risk and, 191f, 196
home blood pressure monitoring and, 76–77, 80
hypertension risk for, 7, 9f
aging and, 340–341, 461
in African Americans, 469, 476
in children and adolescents, 447, 448, 558
systolic blood pressure importance, 10
in isolated systolic hypertension, 173, 174
in untreated hypertension, 157, 162–163, 164–165
myocardial blood flow and, 179
obesity and, 372, 378
pathogenesis of, 178–179

Left ventricular hypertrophy (LVH) (Continued)
treatment of
CHEP 6 guidelines for, 564t
international comparisons of, 573, 574
white-coat hypertension risk for, 87
Left ventricular mass index, elevated. See Left
ventricular hypertrophy (LVH).
Leg. See Lower extremity.
Lemakalim, 299
Leptin
obesity and, 371, 371f
obstructive sleep apnea syndrome and, 138
Libido, diuretics effect on, 227
Liddle’s syndrome, 17t
hypokalemia with, 106
pathophysiology of, 25–26, 26f, 27t, 28f
LIFE. See Losartan Intervention for Endpoint Reduction
in Hypertension (LIFE).
Life expectancy, in U.S., 173
Life insurance industry, 155
Life insurance policies, 155
Lifestyle
as hypertension risk, in India population, 493–495,
494t, 495t
children’s, assessment of, 560
coronary heart disease and, 193–194
Lifestyle modifications, 50, 53, 328
DASH diet plus, 474, 477
dietary, 204–205, 207. See also Diet.
for weight loss, 372, 375, 376
PREMIER trial on, 374–375, 377t, 474
for African Americans, 469, 474, 477
for children and adolescents, 449, 449f
WGTF 4 guidelines for, 558, 560–561, 560f
for chronic disease management, 530, 532
for diabetes-related hypertension, 409–410
for dyslipidemia
and hypertension, 421, 423
estimated need for, 418, 419t
for elderly patients, 458–459, 459t
for heart failure, 341, 343
for peripheral artery disease, 388
for resistant hypertension, 504, 504t
for South Asians, 496
for transplant hypertension, 364
guidelines for, 566
CHEP 6, 564, 565, 565f
for children and adolescents, 558, 560–561, 560f
international comparisons of, 571, 572, 572t, 573,
573t, 575
JNC 7, 409, 555–557, 557f
health care providers role in, 208
nondietary, 205
Lifetime risk
for hypertension, 5, 23
of coronary heart disease, 194
Limbourg study, of home blood pressure monitoring, 74
Linkage analysis
association studies vs., 18
genome-wide, 17
Linkage disequilibrium (LD), 16, 18, 20
Lipid-lowering therapies
adherence issues with, 423–424
antihypertensive drug interactions with, 419–421,
420t
diet as, 421, 423, 424
“global risk” estimates for, 418, 423
historical studies on, 305, 306
international comparisons of, 573, 574
metabolic syndrome and, 422, 422t
regulatory development of, 539, 545
specific principles for, 423
trends in, 190
Lipid solubility. See Lipophilicity.
Lipids
α-adrenergic blockers effect on, 291
β-adrenergic blockers effect on, 236
atherogenic. See Dyslipidemia.
diuretics effect on, 226–227
Lipophilicity
of angiotensin-converting enzyme inhibitors,
240–241, 244
of antihypertensive drugs, obesity and, 378
of β-adrenergic blockers, 233t, 236
of calcium channel blockers, 269, 270t, 273, 275
Lipoprotein (a)
as predictor for coronary artery disease, 195
atherogenic. See Dyslipidemia.
Lisinopril, 240t, 250f
clinical trials on, 219, 222, 244, 246, 247, 353t
outcome-based, 272t, 279, 307, 308, 308f, 311, 312
for diabetes-related hypertension, 411t, 412
for hypertension
in African Americans, 475
in children and adolescents, 450, 451t
in East Asian populations, 489
in elderly patients, 459, 460
for obesity-related hypertension, 378
for stroke prevention, 397
for transplant hypertension, 365t, 366
historical studies on, 306
pharmacology of, 239
renal effects of, 245, 245f
Liver
oxidizing enzymes in, 539
pheochromocytoma metastasis to, 128–129
Liver function tests
impaired, new drug development and, 539
in preeclampsia, 429, 430, 431, 435
Liver transplantation, hypertension related to, 361
Locus-specific admixture mapping, 20
Loop diuretics, 213–215
adverse drug interactions with, 227
for children and adolescents, 450, 453t
for heart failure, 343
for resistant hypertension, 500, 504, 505, 505f
for transplant hypertension, 365, 365t, 366
nephron sites of action, 213, 214f
neurohormonal response to, 217, 224f
pharmacodynamics of, 213–214, 215f
pharmacokinetics of, 213, 214t, 215f
Loop of Henle, diuretics action in, 213, 214f, 214t
Losartan Intervention for Endpoint Reduction in
Hypertension (LIFE), 35, 165, 174, 244, 319t,
322, 476, 542
African Americans in, 476
chronic kidney failure in, 355, 356
diabetic patients in, 411t, 412, 414
elderly patients in, 460–461
heart failure in, 342
outcome-based results of, 256, 257, 258, 259f, 261,
264, 310
resistant hypertension in, 498
stroke in, 397
Losartan potassium
clinical trials on, 35, 159f, 165, 244, 245
efficacy of, 257
for diabetes-related hypertension, 411t, 412
for hypertension
in children and adolescents, 450, 451t
in East Asian populations, 489
in elderly patients, 460–461
for isolated systolic hypertension, 174
for renal arteriopathy, 33
for transplant hypertension, 365t, 366
home monitoring evaluation of, 70f, 78–79, 80
pharmacologic properties of, 234, 255t
regulatory development of, 542, 544
Low birth weight (LBW), in African Americans, 472
Low-density lipoprotein cholesterol (LDL-C)
α-adrenergic blockers effects on, 291
as risk factor, 7, 8f, 12, 327
treatment principles for, 423
global cardiovascular risk and, 190, 195
historical studies on, 305
metabolic syndrome therapy and, 422
oxidative stress and, 39
statins impact on, 420, 420t, 421
vascular wall impact of, 419
Low-frequency head, of stethoscope, placement of,
61–62
Lower extremity
amputations of, 387
pain in, ambulatory, 384, 385, 386
systolic blood pressure ratios of, in peripheral arterial
disease, 386, 386t
Lower urinary tract symptoms (LUTS), α1-
adrenoceptor antagonists and, 286, 288, 291
LUK BRIGHT (United Kingdom’s BRItish Genetics of
HyperTension) study, 18
Index 599
Lund-Johansen studies, 270
Lung(s). See also Pulmonary entries.
carcinoma of, small cell, 148
LUTS (lower urinary tract symptoms), α1-adrenoceptor
antagonists and, 286, 288, 291
LVAD (left ventricular assist device), for heart failure,
346
LVH. See Left ventricular hypertrophy (LVH).
LVV-hemorphin 7, 254
Lymphoma, post-heart transplant, 348
M-mode cube formula, for left ventricular hypertrophy,
179t
M235T polymorphism, 19, 26–27
Macroproteinuria, angiotensin-converting enzyme
inhibitors and, 244, 245, 245f
Macula densa, diuretics effect on, 217
Macular edema, in hypertensive retinopathy, 184, 185t
Magnesium, excretion of, diuretic therapy impact on,
213, 225–226
Magnesium carbonate, 226
Magnesium gluconate, 226
Magnesium intake, dietary
blood pressure response to, 6, 206
CHEP 6 guidelines for, 564
weight loss targets for, 372, 373t
Magnesium loading test, 225
Magnesium oxide, 226
Magnesium sulfate (MgSO4)
for preeclampsia, 436
parenteral, indications for, 225, 226
Magnetic resonance angiography (MRA)
for dementia differentiation, 401
for heart failure staging, 342
for ischemic heart disease assessment, 180
for renovascular hypertension, 95–97
performance characteristics of, 97t, 99
resistant, 501t, 502
for stroke assessment, 183–184
Magnetic resonance imaging (MRI)
for pheochromocytoma localization, 122, 124f, 125,
125f
iodine-123 and, 124f, 125–126, 126f
for stroke assessment, 184, 392
in left ventricular hypertrophy assessment, 179t, 180
Malignancy(ies), post-heart transplant, 348
Malignant hypertension
in untreated hypertension, 165
renal failure and, 164
retinopathy resulting from, 165, 185
Malignant pheochromocytoma, hypertension related to,
129–130
metastatic lesions, 128–129
Malnutrition, bariatric surgery and, 378
Managed care organizations (MCOs), 527, 528, 531
Management of Atherothrombosis with Clopidogrel in
High-Risk Patients (MATCH) study, 399
Manometers. See Sphygmomanometer(s).
Manual of Policies and Procedures (MaPP), 538
MAP. See Mean arterial pressure (MAP).
MAP (mitogen-activated protein) kinases, in
angiotensin II–converting enzyme mediation,
38–39, 38f
MaPP (Manual of Policies and Procedures), 538
Marijuana, research on, 300
MARVAL (Microalbuminuria Reduction with
Valsartan) trial, 258
Masked hypertension, 77, 87
MATCH (Management of Atherothrombosis with
Clopidogrel in High-Risk Patients) study, 399
Maternal syndrome, in preeclampsia, 435–436
Maximal oxygen consumption, myocardial, heart
transplant indications based on, 346
Maximum inflation level (MIL), of blood pressure cuff,
63–64
Maximum ventricular elastance (Emax), 540
MCOs (managed care organizations), 527, 528, 531
MCP-1 (monocyte chemoattractant protein-1),
oxidative stress and, 39
MDL 100 240, for hypertension, 298
MDPIT (Multicenter Diltiazem Postinfarction Trial), 337
MDRD (Modification of Diet in Renal Disease), 186,
353t, 354, 354f
600 Index
Meals, home blood pressure monitoring and, 73, 73t
Mean arterial pressure (MAP)
age factor of, 169, 170f
angiotensin-converting enzyme inhibitors effect on,
245, 245f
as cardiovascular event predictor, 170, 172
hemodynamics of, 171
in chronic kidney disease, treatment goals for,
353f–354f, 354
left ventricular hypertrophy and, 178
Measurement, of blood pressure. See Blood pressure
measurement/monitoring.
Mechanoreceptors, sympathetic activity related to, 29,
30f, 31f
MED (intensive medical therapy), for left ventricle
restoration, 346
Medicaid, benchmarking by, 531, 567
Medical history
for blood pressure measurement, 63
for heart failure assessment, 181
for mineralocorticoid excess states, 106, 116
importance of accurate, 145
in disease management programs, 531, 532
of children and adolescents, 447, 448, 560
Medical illness(es)
chronic
case management for, 527–528
disease management model for, 528, 531, 532f
concomitant. See Comorbidities.
Medical information, consent for release of, 529
Medical records
for community pharmacies, 529–530
for disease management team, 532, 533
Medical Research Council (MRC) Trials, 159, 159f, 161,
161f, 164
elderly patients in, 459t, 463, 463t
lessons learned from, 305–306
on diuretics, 218–219, 220f–221f
adverse event data, 224, 226, 227
in elderly patients, 219
on vascular dementia, 401
Medical reviewer, new drug development role, 536–537
Medicare
benchmarking by, 531, 567
prescription drug benefit of, 529
Medulla oblongata, sympathetic activity of
nucleus tractus solitarius role, 29, 30, 31f, 32
rostral ventrolateral nucleus role, 29, 30–31, 31f
Medullary thyroid carcinoma (MTC), secondary
hypertension related to, 119, 120, 121
Membrane action potential, β-adrenergic blockers effect
on, 231, 232t
Membrane stabilizing activity, of β-adrenergic blockers,
231, 232t
Memory recall, for blood pressure measurement, 60, 60f
MEN 2A (multiple endocrine neoplasia type 2A),
secondary hypertension related to, 119,
120–121, 121t
MEN 2B (multiple endocrine neoplasia type 2B),
secondary hypertension related to, 119,
120–121, 121t
Mendelian forms, of hypertension, 17–18, 17t
pathophysiologic mechanisms of, 25–26, 27t, 28f
Mental stress, increased sympathetic response to, 33
99
Tc-Mercaptopacetyltriglycine, for renovascular
hypertension, 98
Mercury sphygmomanometer
ambulatory blood pressure monitors vs., 90
as “gold standard,” 59, 60–61, 60f
calibration of, 60–61, 60f
environmental concerns about, 58–59
home blood pressure monitors vs., 71, 71f
inspection for quality assurance, 66
replacement options for, 59
MESA. See Multi-Ethnic Study of Atherosclerosis (MESA).
Messenger-responsive receptors, in calcium pump, 268,
269f
Messenger ribonucleic acid (mRNA), angiotensin II
and, 39
Meta-analyses, 316–323
Blood Pressure Lowering Treatment Trialists’
Collaboration as, 317–323. See also Blood
Pressure Lowering Treatment Trialists’
Collaboration (BPLTTC).
criteria for, 316
Meta-analyses (Continued)
description of, 316
in genetic research
association studies, 18–19, 19t
family studies, 18
method models for, 316
need for, 317
of alcohol intake reduction, 204
of angiotensin II receptor blockers, 257, 259f,
264–265, 265f
of calcium channel blockers, 271–273, 273f
of cardiovascular death, 161–162, 162f
of genome search, 18
of heart failure, 162–163
of ischemic heart disease, 157–159, 158f–159f
of potassium intake increase, 203–204
of pulse pressure, in cardiovascular disease, 169–170,
170f
of renal failure, 163–164, 163f
of renovascular hypertension therapies, 102–103
of sodium intake reduction, 202–203, 203f
of stroke mortality, 159–161, 160f–161f, 395, 395f
of stroke prevention trials
blood pressure lowering, 394–399
other interventions, 399–401
primary, 395, 396, 396f, 397f
secondary, 398, 398f
of vascular dementia trials, 402, 402f
prospective projects for, 317
trends of, 316
unbiased strategies for, 316–317
Metabolic acidosis, transplant hypertension and, 365
Metabolic disorders/disturbances
acromegaly associated with, 150
preeclampsia and, 435–436
Metabolic syndrome, 12, 29, 327
α-adrenergic blockers and, 291
coronary heart disease and, 195
diabetes mellitus vs., 406, 407t, 409
dyslipidemia and, 418, 419t
therapy for, 422, 422t
genetics of, 418–419
hypertension in, 406, 407t
in children and adolescents, 447
in East Asians, 488
obesity and, 371, 371f
obstructive sleep apnea syndrome and, 135, 138, 140
resistant hypertension related to, 500f, 508–509
Metabolism
α-adrenergic blockers effects on, 291
calcium channel blockers effects on, 275
of drugs. See also Pharmacokinetics (PK); specific
agent or drug classification.
new drug development and, 539
Metanephrines, urine vs. plasma studies of
for pheochromocytoma, 121f, 122, 123
postoperative follow-up, 128–129
renal failure and, 124
Metastatic lesions, of pheochromocytoma, 128–129, 130
Metformin, for metabolic syndrome, 422, 422t
Methyldopa
breast milk concentrations of, 437
for peripheral arterial disease, 390
for pregnancy-related hypertension, 433t, 434
3-Methylglutaryl–coenzyme A reductase inhibitors,
hepatic, for stroke prevention, 400, 400t
α-Methylparatyrosine (metyrosine), preoperative, for
pheochromocytoma resection, 127
Metolazone
for transplant hypertension, 365t, 366
pharmacokinetics of, 214t, 215
Metoprolol, 236
breast milk concentrations of, 437
combination formulations of, 233–234
elimination characteristics of, 234t
for chronic kidney disease, 356
for hypertension
in African Americans, 476
in children and adolescents, 450, 452t
for peripheral arterial disease, 390
for transplant hypertension, 365t
molecular structure of, 232, 235f
outcome studies on, 272t, 310
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
Metropolitan Life Insurance Company, 551
Mexican Americans. See Hispanics.
Mg2+ loading test, 225
MgSO4 (magnesium sulfate)
for preeclampsia, 436
parenteral, indications for, 225, 226
MI. See Myocardial infarction (MI).
Mibefradil, 539
MICRO-HOPE (Microalbuminuria, Cardiovascular,
and Renal Outcomes in the Heart Outcomes
Prevention Evaluation), 408, 409, 410
Microalbuminuria, 355t
angiotensin-converting enzyme inhibitors and, 244,
245
angiotensin II receptor blockers reduction of,
257–258
coronary heart disease risk and, 195, 419
dyslipidemia impact on, 419
in children and adolescents, 448
in chronic kidney disease, 185–186, 186t, 351
hypertension management and, 357–358
treatment goals for, 354–355
in diabetic nephropathy, 409
in untreated hypertension, 156f, 165
Microalbuminuria, Cardiovascular, and Renal
Outcomes in the Heart Outcomes Prevention
Evaluation (MICRO-HOPE), 408, 409, 410
Microalbuminuria Reduction with Valsartan
(MARVAL) trial, 258
Microaneurysms, in hypertensive retinopathy, 184, 185t
β2-Microglobulin, in chronic kidney disease, 186
Microinjection studies, of atrial natriuretic peptide, 32
Micronutrients, dietary
bariatric surgery and, 378
weight loss targets for, 372, 373t
Microphone, for ambulatory blood pressure
monitoring, 90
Microsatellites
admixture mapping with, 20, 21f
composition of, 16
repeats of, in human genome variations, 16
Microvascular disease
diabetes mellitus and, 407, 408f
renal, 34–35, 35f
Microvascular endpoints, in redefining hypertension,
54, 55
MIDAS (Multicenter Isradipine Diuretic Atherosclerosis
Study), 272t, 276t, 278, 278t
Migraines, angiotensin II receptor blockers and, 257
MIL (maximum inflation level), of blood pressure cuff,
63–64
Mild hypertension
CHEP 6 guidelines for, 561, 562t, 565f
evolving classifications for, 53–54, 54t
sequelae importance of, 10–11, 11f
Mineralocorticoid-dependent renal potassium-wasting
disorders, with hypertension, 106, 107f, 107t
Mineralocorticoid excess states
hypertensive syndromes resulting from, 106–116
aldosterone excess syndromes, 110–116
clinical presentation of, 106
conditions associated with, 106, 107t, 148–149
deoxycorticosterone excess syndromes, 106–108,
108f
11β-hydroxylase deficiency, 107
17α-hydroxylase deficiency, 107–108
adrenocortical enzyme deficiencies, 106–108,
108f
glucocorticoid resistance, 108
initial evaluation of, 106, 107f
mineralocorticoid receptor activation syndromes,
108–110
pathophysiologic mechanism of, 17t, 26f, 27t, 28f
Mineralocorticoid receptors (MRs)
cortisol activation of, hypertension related to,
108–110
in 11β-hydroxysteroid dehydrogenase deficiency,
108–109, 109f
in aldosterone biology, 39–40, 40f
in Cushing’s syndrome, 109–110
mutations of, 27t, 28f
Mineralocorticoids
excessive production of. See Mineralocorticoid excess
states.
hypertension related to

Mineralocorticoids (Continued)
exogenous, 145
in Cushing’s syndrome, 148–149
in aldosterone biology, 40, 40f
postoperative, for pheochromocytoma resection, 129
synthesis pathway of, 108f
transplant hypertension and, 362
Mini-Mental Status Examination (MMSE), 248f, 463
Minoxidil, 299
angiotensin-converting enzyme inhibitors with, 243
for African Americans, 476
for children and adolescents, 450, 453t, 454t
for resistant hypertension, 505f, 506
MIRACLE trial, 345
Mitogen-activated protein (MAP) kinases, in angiotensin
II–converting enzyme mediation, 38–39, 38f
Mitotane, for ACTH-producing tumors, 110
Mitral flow studies, Doppler, for heart failure
assessment, 179t, 181
Mitral insufficiency, surgical treatment of, 345–346
Mitral regurgitation, in heart failure, 341
treatment of, 345–346
Mitral valve reconstruction, for heart failure, 345–346
Mixed sleep apnea, 134, 135t
MLC (myosin light chain), vascular tone regulation role
of, 33, 34f
MMSE (Mini-Mental Status Examination), 248f, 463
Mode Selection Trial (MOST), 345
Moderate hypertension
CHEP 6 guidelines for, 561, 563t, 565f
evolving classifications for, 53–54, 54t
Modification of Diet in Renal Disease (MDRD), 186,
353t, 354, 354f
Moexipril, 240t
Molecular genetics
research trends of, 15
terminology overview for, 16
Molecular structure, of β-adrenergic blockers, 232, 235f
Molokai Heart Study, 488
Monitoring
of blood pressure. See Blood pressure
measurement/monitoring.
of clinical trials, 312–313
Monoamine oxidase inhibitors, hypertension related to,
146
Monocyte chemoattractant protein-1 (MCP-1),
oxidative stress and, 39
Monogenic forms, of hypertension, 17–18, 17t
pathophysiologic mechanisms of, 25–26, 27t, 28f
Monotherapy. See also specific drug classification or agent.
international comparisons of, 573–574, 574f
Monounsaturated fat intake, blood pressure response
to, 206
Morbidity
cardiovascular, perioperative hypertension and,
512–513, 513t
concomitant. See Comorbidities.
obesity associated with, 370
target organ damage and, 178
Morbidity and Mortality after Stroke-Eprosartan vs.
Nitrendipine for Secondary Prevention
(MOSES) trial, 258, 259f, 263, 398
Mortality
diabetes mellitus associated with, 406, 407, 408, 408f
in African Americans, 58, 156, 469
in Hispanics, 483
in South Asians, 493, 494t, 496
obesity associated with, 370
perinatal, in pregnancy-related hypertension, 431
population studies on, 58, 155. See also specific
disease, e.g. Ischemic heart disease.
target organ damage and, 178
with cardiovascular disease
in older individuals, 13, 13t
obstructive sleep apnea associations, 139, 139f
pulse pressure and, 170, 170f
trends of, 9, 9f, 340, 341
with heart failure, 340, 341, 347, 348
with prehypertension, 166
with stroke. See Stroke/stroke mortality.
with untreated hypertension
cardiovascular death and, 161–162, 162f
causes of, 155–157, 156f
heart failure and, 162–163
ischemic heart disease and, 157–159, 158f–159f
Mortality (Continued)
natural history of, 155–157, 156f, 166
renal failure and, 163–164, 163f
stroke and, 159–161, 160f–161f
MOSES (Morbidity and Mortality after Stroke-
Eprosartan vs. Nitrendipine for Secondary
Prevention) trial, 258, 259f, 263, 398
MOST (Mode Selection Trial), 345
Moxonidine, 297–298, 297f, 298t
MRA. See Magnetic resonance angiography (MRA).
MRC. See Medical Research Council (MRC) Trials.
MRFIT. See Multiple Risk Factor Intervention Trial
(MRFIT).
MRI. See Magnetic resonance imaging (MRI).
mRNA (messenger ribonucleic acid), angiotensin II
and, 39
MRs. See Mineralocorticoid receptors (MRs).
MTC (medullary thyroid carcinoma), secondary
hypertension related to, 119, 120, 121
Mucosal neuromas, secondary hypertension related to,
120–121
Müller’s maneuver, obstructive sleep apnea syndrome
and, 136–137, 137f
Multi-Ethnic Study of Atherosclerosis (MESA), 195
East Asians in, 487
Hispanics in, 483–484, 484f
Multicenter Diltiazem Postinfarction Trial (MDPIT), 337
Multicenter Isradipine Diuretic Atherosclerosis Study
(MIDAS), 272t, 276t, 278, 278t
Multiple endocrine neoplasia type 2A (MEN 2A),
secondary hypertension related to, 119,
120–121, 121t
Multiple endocrine neoplasia type 2B (MEN 2B),
secondary hypertension related to, 119,
120–121, 121t
Multiple Risk Factor Intervention Trial (MRFIT)
cardiovascular disease findings, 50, 158, 161
cardiovascular risk among incident diabetics in, 275
cholesterol intake data from, 206
diabetic patients in, 407
diuretics in, 222, 224
elderly patients in, 458
lessons learned from, 305
mild hypertension importance, 10–11, 11f
renal failure findings, 164, 352
stroke findings, 160, 162f
systolic blood pressure findings, 9, 9f
Multiplicative effect, of gene-environment interactions,
22–23
Multisite Stimulation in Cardiomyopathy (MUSTIC)
Study, 345
Multivariable risk estimation, for coronary heart
disease, 192–193, 192f
newer issues for, 194–195, 194f
Muscular conduit arteries, 181, 182
MUSTIC (Multisite Stimulation in Cardiomyopathy)
Study, 345
Mutations, gene. See Genetics.
Mycophenolate mofetil, transplant hypertension and, 362
Myocardial infarction (MI)
angiotensin-converting enzyme inhibitors for, 239,
240, 240t, 242, 243
end-organ effects and, 246–247
assessment of, 179t, 180
β-adrenergic blockers’ effects on, 234, 236
calcium channel blockers’ effect on, 278
CHEP 6 guidelines for, 564t
diabetes mellitus and, 407, 408f
hypertension management with
non-ST-segment, 336
ST-segment elevation, 336–337
hypertension risk for, 7, 8, 8f–9f
cholesterol levels and, 190, 191f–192f, 418, 420
death trends with, 161–162
diuretic therapy impact on, 29, 219, 222
in older individuals, 13, 13t
inherited, 29
renin levels and, 37
hypertensive emergency with, 519
in East Asians, 490
in untreated hypertension, 156f, 157–158
outcome studies on, 310–311
perioperative hypertension and, 512–513, 513t, 515
management of, 514–515, 515f
peripheral artery disease and, 385
Index 601
Myocardium
aldosterone effects on, 295
blood flow in
left ventricular hypertrophy and, 179, 333
perfusion pressures for, 333–334, 333f
hypertension and aging impact on, 340–341
oxygen consumption of
angiotensin-converting enzyme inhibitors’ effects
on, 243
demand factors, 328
maximal, heart transplant indications based on,
346
Myocytes, ST-segment elevation infarction and, 341
Myofibrils, cardiac, in left ventricular hypertrophy,
178–179
Myosin, calcium channel blockers’ effects on, 268, 269f
Myosin light chain (MLC), vascular tone regulation role
of, 33, 34f
“N-of-1” trials, home monitoring evaluation of, 79
Na+/chloride (Cl-) cotransporter gene, 25, 27t
NAD(P)H (nicotinamide adenine dinucleotide
phosphate) oxidase, angiotensin II and,
38f, 39
Nadolol
molecular structure of, 232, 235f
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
Naloxone, use with anesthetics, hypertension related to,
145
Narcotics, hypertension related to, 145
“Narrow sense” heritability, of hypertension, 15–16
Nateglinide and Valsartan in Impaired Glucose
Tolerance Outcomes Research (NAVIGATOR)
study, 414
National Ambulatory Medical Care Survey, 484
National Cholesterol Education Program, Third Adult
Treatment Panel of, 158, 406, 418, 419t, 423
National Committee for Quality Assurance (NCQA),
blood pressure control criteria of, 527, 566
National Guideline Clearing House, 552
National Health and Nutrition Examination Surveys
(NHANES)
African Americans in, 468, 469, 477
blood pressure measurement for, 58
blood pressure upstaging in, 7, 566
children and adolescents in, 447
chronic kidney disease in, 352, 354
elderly patients in, 457
Epidemiological Follow-up Study, 469
Hispanics in, 482–483, 483t, 484
hypertension definition in, 49–50, 50f
ischemic heart disease in, 157
obesity trends in, 207–208, 370
peripheral arterial disease in, 384, 386
prevalence trends based on, 3–4, 4f, 4t
in older individuals, 12–13, 13t, 169, 174
resistant hypertension in, 507, 508, 509
systolic blood pressure findings of, 10, 10t
National Heart, Lung, and Blood Institute (NHLBI),
419, 552
National High Blood Pressure Education Program
(NHBPEP)
Advisory Panel of, blood pressure staging
recommendations, 7
Coordinating Committee of 2005, 552, 552t
definition recommendations by, 54
history of, 552
Joint National Committee of. See Joint National
Committee (JNC).
mortality trends resulting from, 155
pregnancy work group, 432, 434, 435
working group of
for children and adolescents, 552, 553t
practice guidelines of, 558–561, 559t, 560f
for elderly patients, 461, 462
National Hospital Ambulatory Medical Care Survey,
484
National Institutes of Health (NIH), 552
clinical trial monitoring, 312, 313
on obesity surgery, 378
population-based study sponsored by. See Multi-
Ethnic Study of Atherosclerosis (MESA).
602 Index
National Intervention Cooperative Study in Elderly
Hypertension (NICS-EH), 221f, 272t, 319t, 487,
490
National Kidney Foundation (NFK)-Kidney Disease
Outcomes Quality Initiative (K/DOQI)
Working Group, 352, 354, 355, 357
National Survey on Cardiovascular Diseases, 487
National Transplantation Study, 348
Native Americans
hypertension in
genetic studies on, 482
mortality trends of, 161
low birth weight in, 472
Native Hawaiians
hypertension in
detection importance for, 490
prevalence of, 488, 488t
treatment of
considerations for, 488–489
outcome studies of, 487, 489–490
side effects with, 487, 490
low birth weight in, 472
Natriuresis, 41
acromegaly and, 150
impaired, 28, 28f
in chronic phase of diuretic response, 218
in mineralocorticoid excess states, 111f–112f, 108, 110
Natriuretic peptide receptors (NPRs), 42
Natriuretic peptides
in African Americans, 469t, 471
inhibition of, 298–299, 299f
mediating role of, 26f, 41–42, 41f
obesity and, 371f, 372
NAVIGATOR (Nateglinide and Valsartan in Impaired
Glucose Tolerance Outcomes Research) study,
414
NCCT gene, 25, 27t
NCQA (National Committee for Quality Assurance),
blood pressure control criteria of, 527, 566
NDA (New Drug Application), 535
Nebivolol, 298
elimination characteristics of, 234t
nitric oxide potentiating activity of, 232
pharmacokinetic properties of, 232–233, 233t
Negative inotropic activity, of β-adrenergic blockers,
231, 236
Nelson’s syndrome, 110
Neonates, hypertension in, 440, 446, 558
NEP inhibitors, for hypertension, 298, 299f
Nephrectomy, native, for transplant hypertension, 367
Nephron, diuretics action in, 213, 214f
adaptation to, 216
Nephropathy. See also Kidney disease.
diabetic
angiotensin-converting enzyme inhibitors for,
239, 240, 240t, 244–245, 357
angiotensin receptor blockers and, 257–260, 356–359
calcium channel blockers cautions with, 280–281
CHEP 6 guidelines for, 564t
microalbuminuria with, 409
prevalence of, 409
ischemic, renovascular hypertension with, 94
resistant hypertension related to, 509
Nephrotic syndrome, loop diuretics and, 214
Nephrotoxicity
aminoglycoside, diuretics and, 227
of calcineurin inhibitors, 362
Nerve(s), in smooth muscle, 286–287, 287f
Neurofibromatosis type 1 (NF1), secondary
hypertension related to, 119, 121t, 122
Neurohormonal mechanism
diuretic therapy and, 216–217, 223
adaptive, 223, 224f
of atrial natriuretic peptide expression, 42, 42f
of heart failure, 181, 340–341
of hypertension, in African Americans, 469t, 470,
471–472
of vascular smooth muscle cell regulation, 286
Neuroimaging
for dementia differentiation, 401
for stroke assessment, 184, 392
Neurologic disorders
hypertension related to, in children and adolescents,
446, 446t
pheochromocytoma vs., 119, 120t
Neuromas, mucosal, secondary hypertension related to,
120–121
Neuronal groups, sympathetic, in blood pressure
control, 30–31, 36
Neurons, vasomotor, 286
Neuropathy, autonomic, diabetes-related hypertension
and, 413
New Drug Application (NDA), 535
New molecular entity (NME), of antihypertensive
drugs, 535
developmental overview of, 536–538. See also
Regulatory development.
New York Heart Association, heart function grades of,
181, 236
in heart failure, 342f, 343f, 344, 345
Newborns, hypertension in, 440, 446, 558
NF1 (neurofibromatosis type 1), secondary
hypertension related to, 119, 121t, 122
NF1 tumor suppressor gene, 27t
secondary hypertension related to, 122
NFK (National Kidney Foundation)-K/DOQI (Kidney
Disease Outcomes Quality Initiative) Working
Group, 352, 354, 355, 357
NHANES. See National Health and Nutrition
Examination Surveys (NHANES).
NHBPEP. See National High Blood Pressure Education
Program (NHBPEP).
NHLBI (National Heart, Lung, and Blood Institute),
419, 552
Niacin, for dyslipidemia, 422, 422t
Nicardipine
clinical outcome studies on, 272t
for peripheral arterial disease, 390
for transplant hypertension, 365t, 366
intravenous
for children and adolescents, 450, 454t
for hypertensive emergencies, 519, 521–522, 521t
NICOLE study, 319t
Nicorandil, 299
Nicotinamide adenine dinucleotide phosphate
(NAD(P)H) oxidase, angiotensin II and, 38f, 39
Nicotine. See Cigarette smoking.
NICS-EH (National Intervention Cooperative Study in
Elderly Hypertension), 221f, 272t, 319t, 487,
490
Nifedipine
breast milk concentrations of, 437
clinical trials on, 161f, 221f
outcome-based, 272t, 279
extended-release, for children and adolescents, 450,
452t
for East Asian populations, 489
for elderly patients, 459
for hypertension, 269, 270t
for peripheral arterial disease, 390
for preeclampsia, 436, 437t
for pregnancy-related hypertension, 433t, 434
for primary aldosteronism, 115
for transplant hypertension, 365t, 366
Nighttime blood pressure. See also Nocturnal entries.
ambulatory monitoring of, 85–86, 86f
in clinical trials analysis, 88–90, 89t, 90t
NIH. See National Institutes of Health (NIH).
Nipradilol, nitric oxide potentiating activity of, 232
Nisoldipine, 272t
Nitrates
α-adrenergic blockers vs., 291
for isolated systolic hypertension, 174
Nitrendipine, 276t
for diabetes-related hypertension, 412
for hypertension
in East Asian populations, 489
in elderly patients, 460, 462t
for stroke prevention, 258, 259f, 263, 398
Nitric oxide (NO)
aldosterone and, 39, 40f
angiotensin-converting enzyme inhibitors effects on,
241
β-adrenergic blockers potentiating activity for, 231
diuretic therapy impact on, 213, 214f
endothelial, hypertension related to, 148, 341
heart failure impact on, 341
in African Americans, 469t, 471, 472, 477
obesity and, 371, 379
oxidative stress impact on, 39
Nitric oxide (Continued)
pathophysiologic role of, 26f, 39, 40
substance P and, 43
with dyslipidemia, and hypertension, 419
Nitric oxide synthase (NOS)
as pathophysiologic factor, 36
candidate genes of, 19t
endothelial, reduction of, 36
Nitroglycerin, intravenous, for hypertensive
emergencies, 519, 520t, 521–522
Nitroprusside. See Sodium nitroprusside.
NKCC2 gene, 27t
NME (new molecular entity), of antihypertensive
drugs, 535
developmental overview of, 536–538. See also
Regulatory development.
NO. See Nitric oxide (NO).
No-observed-adverse-effect level (NOAEL), 537
No treatment control group, in new drug development,
540–542, 541f
NOAEL (no-observed-adverse-effect level), 537
Nocturnal hypertension, 85
acromegaly impact on, 150
diabetes-related hypertension and, 413
“dipping” vs. maintaining, 85–86, 86f. See also
Nondipping/nondippers.
in African Americans, 469t, 470
obstructive sleep apnea syndrome and, 135, 136, 137,
138f, 141
organ transplants and, 362–363, 363f
Nocturnal hypotension
acromegaly impact on, 150
attenuated, in African Americans, 478–479
Binswanger’s lesions from, 165
in elderly patients, 462–463
Non-ST-segment myocardial infarction, hypertension
management with, 336
Nonadherence, patient
as blood pressure control factor, 527
assessment of, 565, 567
improvement strategies for, 500f, 507, 509
in dyslipidemia treatment regimens, 423–424
in outcome studies, 312, 312t
resistant hypertension related to, 500f, 506–507
Nondipping/nondippers
acromegaly and, 150
African Americans as, 470
ambulatory blood pressure monitoring of, 85, 87
diabetes-related hypertension and, 413
obstructive sleep apnea syndrome and, 135, 136, 137,
138f, 141
Nonfederal organizations, representation in education
program, 552, 552t–553t
Nonhypertensive individuals. See Normotension.
Noninferiority trials, superiority vs. equivalence, 307–310
Non–insuliin-dependent diabetes mellitus. See Type 2
diabetes mellitus.
Noninvasive testing, for perioperative hypertension,
514, 515, 515f
Nonrenin enzymes, 37, 37f
Nonsteroidal anti-inflammatory drugs (NSAIDs)
angiotensin-converting enzyme inhibitors and, 241
diuretics effects and, 213, 214, 225, 227
elderly patients use of, 458
hypertension related to, 146, 147
mechanism of action, 147
resistant hypertension related to, 508, 508t
Nordic Diltiazem (NORDIL) study, 221f, 272t, 273,
274t, 275, 276t, 319t
Norepinephrine/noradrenaline
dopamine-2 receptor agonists effects on, 296
in salt-sensitive hypertension, 31–32
nocturnal, acromegaly impact on, 150
obesity and, 371, 377
pathophysiologic role of, 29–30, 30f, 32
urine vs. plasma studies of
for pheochromocytoma, 121f, 122, 123
renal failure and, 124
vascular tone and, 33
Normotension
CHEP 6 guidelines for, 561, 562t
diet and
factors that maintain, 201–205
factors with limited effects, 205–207
home monitoring of, 74

Normotension (Continued)
JNC 7 guidelines for, 554t, 555
measurement accuracy concerns, 144
WGTF 4 guidelines for, 558, 559t
white-coat, clinical significance of, 87
Norris, George W., 551
Northern Manhattan Stroke Study, 483
NOS. See Nitric oxide synthase (NOS).
NPRs (natriuretic peptide receptors), 42
NSAIDs. See Nonsteroidal anti-inflammatory drugs
(NSAIDs).
NTS (nucleus tractus solitarius)
imidazoline agonists effects on, 297f
sympathetic activity of, 29, 30, 31f, 32
Nucleus ceruleus, imidazoline agonists effects on, 297f
Nucleus tractus solitarius (NTS)
imidazoline agonists effects on, 297f
sympathetic activity of, 29, 30, 31f, 32
Nurse case management, of hypertension, 528–529
Nurse clinicians
in disease state management, integrated team role,
532–533, 532f
pharmacist collaboration with, 530–531
Nurses’ Health Study, 206
obesity in, 370
Nutrients, dietary. See also Diet; specific nutrient,
e.g., Fatty acids.
weight loss targets for, 372–373, 373t
Nutrition counseling, 375
for peripheral artery disease, 388, 389
Obesity, 370–380
abdominal, 370
insulin resistance associated with, 418–419
resistant hypertension and, 509
antihypertensive treatment in, 378–379, 380t
as risk factor, 5–6
diet and, 201–202, 202f
in African-American population, 196
inherited, 29
rising epidemic of, 12
blood pressure and
measurement problems with, 144, 370
obesity surgery effect on, 378
weight loss effect on, 372–378, 373t, 374f–376f, 377t
body mass index and
calculation of, 370, 371t
classification based on, 370, 371t
central, 370
in African Americans, 472, 473f
coronary heart disease and, 193, 194, 196, 406
essential hypertension role, 34, 35f
fat burden assessment in, 370, 371t
hypertension mechanisms of, 370–372, 371f
cardiac, 372
free fatty acids, 372
hormonal, 371–372
natriuretic peptides, 372
renal, 370
sleep apnea syndrome, 372
sympathetic nervous system, 370–371
in African Americans
central, 472, 473f
weight loss for, 477
in children and adolescents, 6, 207–208, 447
weight loss for, 449–450, 449f
WGTF 4 guidelines for, 558, 560
incidence of, 370
morbidity associations, 370, 378
mortality with, 370
obstructive sleep apnea syndrome and, 135, 136t, 138f
preeclampsia and, 435
resistant hypertension related to, 500f, 508–509
transplant hypertension and, 364
visceral, 370
Obesity surgery, blood pressure response to, 378
Objective medication intolerance, 506
Observational studies, 307
of calcium channel blockers, 271
of stroke prevention, 397–399
on sodium intake reduction, 203
Observer bias, in blood pressure measurement, 64–66
form for evaluating, 64, 65f
Observer positioning, for blood pressure measurement,
63, 63f
critical skills related to, 60, 60f
Obstructive sleep apnea syndrome (OSAS), 134–141
central nervous system consequences of, 139, 140
clinical features of, 134, 135t
clinical implications of, 32, 140–141
continuous positive airway pressure for, 140, 140f
epidemiology of, 134–135, 136t
hypertension related to, 135–141
as public health issue, 141
clinical evidence of, 135–136, 136t, 137f
clinical importance of, 139, 139f
management of, 140, 140f–141f
pathophysiologic mechanisms of, 136–139,
137f–138f
risk factors for, 136, 363
in African Americans, 469
metabolic consequences of, 138
pathophysiology of, 136–139
baroreflex changes, 137, 137f–138f
chemoreflex changes, 136–137, 137f–138f
endothelial function and, 138, 138f
hemodynamic patterns of, 136–137, 137f–138f
inflammation and, 138, 138f
sympathetic activity and, 135, 136t, 137, 137f
systemic humoral changes, 138, 138f
resistant hypertension related to, 501t, 503
Occupational Health and Safety Administration,
U.S., 58
OCTAVE (Omapatrilat Cardiovascular Treatment
versus Enalapril) Study, 298–299
Octreotide (SMS 201-995), for ACTH-producing
tumors, 110
ODI (oxygen desaturation index), in sleep disorders,
134, 139
Office measurement of blood pressure, 58–66
ambulatory monitoring vs., 86, 87f
CHEP 6 guidelines for, 561
environmental concerns about, 58–59
equipment inspection recommendations, 66
errors in diagnosing, 66, 66t
for children and adolescents, 441
for transplant hypertension, 363
guidelines for, international comparisons of, 571,
572t, 573t, 575t
historical perspective of, 58
home monitoring vs., 74–76
comparisons of, 74–75, 74f
correlations between, 76, 76t
in clinical trials, 80–81, 80t
white-coat effect and, 75, 77–78
improvement strategies for, 59–60, 59f
mercury in, 58–59
positioning for, patient and observer, 63, 63f
proper technique for
critical skills for, 60, 60f
cuff application accuracy, 62–63, 62f, 62t
manometer calibration in, 60–61, 60f
measuring technique in, 63–64
reading accuracy, 63, 63f
stethoscope use and, 61–62
reading selection for recording, 64
staff knowledge assessment for, 66
standardized evaluation of observer, 64–66
form for testing, 64, 65f
steps for taking, 64
technical problems of, 144, 172
Office resistant hypertension, 499, 500f. See also White-
coat hypertension.
Office versus Ambulatory Blood Pressure Study, 86, 87f
Office visits, as blood pressure control factor, 527, 532
Ohasama study, of home blood pressure monitoring,
72, 74, 75, 77
Older individuals. See Elderly.
Oliguria, in preeclampsia, 436
Olmesartan medoxomil, 255t, 256
Omapatrilat, 298
Omapatrilat Cardiovascular Treatment versus Enalapril
(OCTAVE) Study, 298–299
Omnivorous diet, risk related to, 6
Omron IC home blood pressure monitor, 71, 71f
teletransmission of readings, 82
Once-daily dosing, ambulatory blood pressure
monitoring for, 88
Index 603
Ongoing Telmisartan Alone and in Combination with
Ramipril Global Endpoint Trial (ONTARGET),
263, 414
Optic fundus, in hypertensive retinopathy, 184–185,
185f
Optic nerve, in hypertensive retinopathy, 185, 185t
Optimal Trial in Myocardial Infarction with the
Angiotensin II Antagonist Losartan
(OPTIMAAL), 258, 259f, 262, 308
Oral appliances, for obstructive sleep apnea syndrome,
140
Oral contraceptives, hypertension related to, 145, 146
Organ rejection
in heart transplant, 347–348
in transplant hypertension, 363–364
Organ transplant(s), hypertension related to. See
Transplant hypertension; specific organ, e.g.,
Bone marrow transplantation.
Orlistat, blood pressure response to, 376–377
Orthostatic hypotension
diabetes-related hypertension and, 413
with α1-adrenoceptor antagonists, 292
OSAS. See Obstructive sleep apnea syndrome (OSAS).
Oscillometric devices, for blood pressure measurement,
59
ambulatory, 90
in home, 70, 71
indications for, 144
use in children, 558
Osler, William, 49, 156
Osler maneuver, 499
for blood pressure measurement, 144
Osmotic demyelinating syndrome, 223
Outcome labeling claims, for new drugs, 543–544
Outcome study(ies), 305–313
design issues of, 307–313
control group choice, 307–310, 308f
endpoint definition, 310–311
randomization, 307
sample size and power, 311–312, 312t
superiority vs. equivalence vs. noninferiority,
307–310, 308f
history of, 305–306
implementation issues with, 307–313
simplicity, 312–313
unbiased assessment, 310–311, 310f, 311t
in East Asians, 489–490
lessons learned from, 305–306
meta-analyses and, 316–323. See also Meta-analyses.
on angiotensin II receptor blockers, 258–264, 259f
on cardiovascular risk, 7–8, 8f, 11, 11f, 29
on chronic kidney disease, long-term, 353–354, 353t
Outcomes, with hypertension. See Sequelae; specific
outcome.
Outpatient management, of hypertension, in children
and adolescents, 450, 451t–453t
Over-the-counter drugs, hypertension related to, 146
Overweight
diabetes mellitus associated with, 409–410
in children and adolescents, 446, 448
in East Asians, 488
obstructive sleep apnea syndrome and, 135, 136t
Oxidant superoxide anion, angiotensin II and, 39
Oxidative stress. See also Reactive oxygen species.
angiotensin II and, 39
calcium channel blockers and, 279
in diabetes mellitus, 408–409, 409f
obstructive sleep apnea syndrome and, 138
pathophysiologic role of, 39, 40
with dyslipidemia, and hypertension, 419, 419f
Oxidizing enzymes, in liver, 539
Oxprenolol
elimination characteristics of, 234t
molecular structure of, 232, 235f
pharmacokinetic properties of, 232–233, 233t
18-Oxycortisol, in glucocorticoid-remediable
aldosteronism, 115–116, 116f
Oxygen consumption, myocardial
angiotensin-converting enzyme inhibitors’ effects on,
243
demand factors, 328
maximal, heart transplant indications based on,
346
Oxygen desaturation index (ODI), in sleep disorders,
134, 139
604 Index
p22phox, angiotensin II and, 39
Pacemaker, heart failure indications for, 344–345
Pacific Islanders. See Native Hawaiians.
PACK (Prevention of Atherosclerotic Complications
with Ketanserin) study, 387
Paclitaxel, hypertension related to, 146
PAD. See Peripheral arterial disease (PAD).
Pain
leg, ambulatory, 384, 385, 386
perioperative hypertension and, 512, 513, 513t
PAMELA study, of home blood pressure monitoring, 74
Paragangliomas, extra-adrenal catecholamine-secreting,
119. See also Pheochromocytoma.
Parasympathetic nervous system (PNS)
obstructive sleep apnea syndrome and, 137,
137f–138f, 140
vascular smooth muscle cell regulation by, 286
Parathyroid hormone-related peptide,
pheochromocytoma-related secretion of, 119
Parenchymal disease, renal
in children, 446, 446t, 448
resistant hypertension related to, 499, 500, 500f, 501t
Parenteral drugs, for hypertensive emergencies, 517,
519, 520t–521t
in children and adolescents, 450, 454t
PART2 (Prevention of Atherosclerosis with Ramipril
Trial no. 2), 159f, 319t
Partial agonist activity, of β-adrenergic blockers, 231
Pathophysiology, of hypertension, 25–43
adrenomedullin role in, 43
aldosterone role in, 39–40, 40f
angiotensin II role in, 39
arterial stiffness as, 32, 36–37, 36f
calcitonin gene–related peptide and, 43
cardiovascular risk factors, inherited, 29
contributing factors, 25, 43. See also Risk factors.
endothelial dysfunction and, 40
endothelin role in, 41
genetic contributions, 25–29. See also Genetics.
in older individuals, 12–13, 13t
kallikrein-kinin system and, 42–43
natriuretic peptides role in, 41–42, 41f–42f
oxidative stress and, 39, 40
renal microvascular disease in, 34, 35f
renin-angiotensin-aldosterone system and, 19t,
37–39, 37f–39f
secular trends, 3–4, 4f, 4t
substance P role in, 43
sympathetic nervous system activity, 26f, 29–33,
30f–32f
uric acid role in, 35–36
vascular remodeling and, 33–33, 34f
vascular tone and, 33
vasodilator mediation of, 41–43
Patient education
for disease management, 530, 532
international comparisons of, 572t, 573t, 574–575
Patient noncompliance. See Nonadherence.
Patient positioning, for blood pressure measurement
arm position, 62–63
CHEP 6 guidelines for, 561
in children and adolescents, 441
knowledge assessment of, 66
seated vs. supine, 63, 63f
Patient rights, in clinical trials, 312–313
PATS (Post-Stroke Antihypertensive Treatment Study),
159f, 161f, 162f
East Asians in, 398, 398f, 490
PD. See Pharmacodynamics (PD).
PDUFA (Prescription Drug User Fee Act) of 1992, 538
PEACE (Prevention of Events with Angiotensin-
Converting Enzyme Inhibition), 159f, 162, 243,
244, 411t, 414
Peak and trough ratio, blood pressure monitoring for
ambulatory, 89
in home, 72, 80
Pediatric Nutrition Surveillance System, of CDC, 472
Pediatric patients. See Adolescents; Children.
Pediatric Research Equity Act of 2003, 546
Pelvic relaxation syndrome, α1-adrenoceptor
antagonists and, 292
Penbutolol
elimination characteristics of, 234t
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
PEPI (Postmenopausal Estrogen/Progestin
Intervention) trial, 465
Peptides
as vasoconstrictors, 296
antagonists for, new investigations on, 296–297
natriuretic
in African Americans, 469t, 471
inhibition of, 298–299, 299f
mediating role of, 26f, 41–42, 41f
obesity and, 371f, 372
vasoactive
angiotensin receptor blockade and, 254, 264
intestinal
pheochromocytoma-related secretion of, 119
secondary hypertension and, 119
mediating role of, 41, 42–43
Percutaneous balloon dilatation, for coarctation of the
aorta, 148
Percutaneous coronary interventions, for angina,
unstable, 336
Perfusion pressure, for coronary blood flow, 333–334,
333f
Perindopril, 240t, 243
clinical trials on, 161, 164, 247
Perindopril Protection against Recurrent Stroke Study
(PROGRESS), 159f, 161, 161f, 162f, 164, 247,
280, 319t
East Asians in, 398, 490
elderly patients in, 463, 463t
secondary prevention results, 398, 398f
vascular dementia in, 402, 402f
Perioperative hypertension, 512–515
antihypertensive medication effects on, 513–514
cardiovascular morbidity associated with, clinical
predictors of, 512–513, 513t
hypertensive emergency with, 522
management of
β-adrenergic blockers in, 513–514, 515
algorithm for, 514–515, 515f
angiotensin-converting enzyme inhibitors in, 514,
515
angiotensin II receptor blockers in, 514, 515
noninvasive testing for, 514, 515, 515f
Perioperative Ischemic Evaluation (POISE) trial, 514
Peripartum heart failure, preeclampsia and, 436
Peripheral arterial disease (PAD), 384–390
angiotensin-converting enzyme inhibitors for, 243
ankle-brachial index of, 182–183, 384
causes of, 385
clinical diagnosis of, 384
comorbidities of, 384, 385
diabetes mellitus and, 407, 408f
epidemiology of, 384–385
hypertension contributing to, 384, 385–388
angiography prevalence of, 387
ankle-brachial index prevalence with, 386, 387
critique of studies of, 388
incidence studies of, 387, 388f
intermittent claudication prevalence with, 385,
388f
noninvasive tests prevalence of, 386–387
outcome studies of, 387
progression of, 387
randomized controlled trials, 387
hypertension treatment in, 388–390
β-adrenergic blockers, 389
angiotensin-converting enzyme inhibitors, 389
calcium channel blockers, 389–390
CHEP 6 guidelines for, 564t
conclusive recommendations on, 390
multiple class comparisons, 390
nonpharmacologic, 388–389
pharmacologic, 389–390
principles of, 388
prevalence of, 384, 385f
risk factors for, 384
subclinical detection of, 384, 385
systolic blood pressure in, 386–387
age- and sex-adjusted percentages by disease
status, 386, 386t
age-adjusted mean levels by disease status, 386,
386t
odds ratios of isolated lesions, 387, 387t
Peripheral edema, from calcium channel blockers, 273,
274t, 275, 275f
Peripheral perfusion, mechanisms of, 29–30
Peripheral vascular disease
hypertension risk for, 7, 8f
in untreated hypertension, 164
Peripheral vascular resistance (PVR). See also Systemic
vascular resistance (SVR).
arterial blood pressure regulation by, 286
in African Americans, 469t, 472
in isolated diastolic hypertension, 169, 170f
in isolated systolic hypertension, 171, 174
preeclampsia and, 436
Peroneal artery, peripheral artery disease in, 385
Peroxisome proliferator-activated receptor γ (PPARγ),
mutations in, 17t
Peroxynitrite, oxidant, angiotensin II and, 39
PET (positron emission tomography) scan, for
pheochromocytoma localization, 126, 126f
PHA1 (pseudohypoaldosteronism type 1), dominant vs.
recessive, 17t, 27t, 28f
Pharmaceutical companies, representation in education
program, 552t–553t, 553
Pharmacist-managed clinics, for disease management,
530
Pharmacists, in disease state management, 529–531
clinic model of, 530
community pharmacy model of, 529–530
integrated team role, 532–533, 532f
nurse collaboration model of, 530–531
physician collaboration model of, 530
trends of, 529
Pharmacodynamics (PD)
in new drug development, 539–540
of α-adrenergic blockers, 287–288, 289f
of β-adrenergic blockers, 231–232, 232t
of angiotensin II receptor blockers, 254–257, 255t
of loop diuretics, 213–214, 215f
Pharmacogenetic studies, of hypertension, 20–21
adrenergic antagonists, 20, 32, 33
pathophysiology mechanisms and, 25, 26, 28–29
Pharmacokinetics (PK)
in new drug development, 537, 538–539
of β-adrenergic blockers, 232–233, 233t, 234t, 235f
of angiotensin II receptor blockers, 254–257, 255t
of calcium channel blockers, 269, 270t
of diuretics, 213–215, 214t
Pharmacologic disorders, pheochromocytoma vs., 119,
120t
Pharmacology, in new drug development, 538–540
Pharmacotherapy
adherence to. See also Nonadherence.
factors for, 527
improvement strategies for, 500f, 507, 509
α-adrenergic blockers, 286–292. See also α-
Adrenergic blockers.
β-adrenergic blockers, 231–236. See also β-
Adrenergic blockers.
angiotensin-converting enzyme (ACE) inhibitors,
239–250. See also Angiotensin-converting
enzyme inhibitors.
angiotensin receptor blockers, 254–265. See also
Angiotensin II receptor blockers (ARBs).
antagonizing, resistant hypertension related to,
507–508, 508t
calcium channel blockers, 268–282. See also Calcium
channel blockers (CCBs).
CHEP 6 guidelines for
algorithm for, 564t, 565f
compelling indications, 562t–563t, 564–565
clinical perspectives of. See Antihypertensive drug
therapy.
diuretics, 213–227. See also Diuretic therapy.
for African Americans, 477–479, 478f
α-adrenergic blockers in, 470
angiotensin-converting enzyme inhibitors in, 242,
247, 475, 496
quinapril response distributions, 468, 469f, 475
angiotensin II receptor blockers in, 468
attenuated nocturnal BP decline and, 478–479
β-adrenergic blockers in, 236, 468, 470, 496
calcium channel blockers in, 270, 468, 475, 496
diuretics in, 222, 475–476, 496
goals of, 478
intravascular volume limitation, 478, 478f
monotherapies, 468, 469f, 475, 477–478
racial differences in, 478

Pharmacotherapy (Continued)
for children and adolescents, 449f, 450, 560f
for emergencies and urgencies, 454t
outpatient, 451t–453t
WGTF 4 guidelines for, 559t, 560–561, 560f
for chronic kidney disease related hypertension,
357–358, 357t
for dyslipidemia
adherence issues with, 423–424
combination, 424
estimated need for, 418, 419t
specific principles of, 423
for elderly patients
clinical trials on, 159f, 458, 462t, 463t
cognitive impairment related to, 463–464, 463t
diuretics as, 219, 222f
efficacy of, 236, 242, 245
for combined systolic-diastolic, 459–460, 459t
for isolated systolic, 460–461, 460t
for very old patients, 464
for pregnancy-related hypertension
chronic, 432–435, 433t
preeclampsia, 432, 436, 437t
for transplant hypertension, 364–366, 365t
for vascular dementia, 401–402, 402f
for weight loss, blood pressure response to, 376–378
genetic research applications for, 20, 21, 23
hypertension related to, 145–146, 147
international comparisons of, 572t, 573t, 575t
for first-choice drugs, 573–574, 574f–575f
for prehypertension, 572–573
for specific indications, 574
major agreements, 571, 572f
monotherapy vs. combination, 572t, 573t, 574,
574f
on other issues, 574–575
JNC 7 guidelines for adults, 554t
algorithm of, 557f
compelling indications, 555, 556–557, 556t
lipid-lowering. See Lipid-lowering therapies.
new drugs for, 295–300. See also Investigational new
drugs (INDs).
parenteral, for hypertensive emergencies, 519,
520t–521t
in children and adolescents, 450, 454t
pharmacist practice settings for, 529–531
clinic model of, 530
community pharmacy model of, 529–530
nurse collaboration model of, 530–531
physician collaboration model of, 530
trends of, 529
pheochromocytoma diagnosis and, 123, 123t, 124f
potassium excretion impaired by, 204
racial/ethnic perspectives of. See specific ethnicity,
e.g. South Asians.
resistance to, 504–506. See also Resistant
hypertension; specific drug, e.g. Insulin
resistance.
dietary approaches to, 504, 504t
diuretic treatment importance in, 504–505
lifestyle approaches to, 504, 504t
physician inertia and, 506, 509
rational multidrug program for, 505–506, 505f
reasons for, 504, 504t
WGTF 4 guidelines for children
algorithm of, 560f
compelling indications, 558, 559t, 560–561
Pharmacotherapy Specialists, Board Certified, 529
Pharmacy/pharmacists, community, disease
management role, 529–530
Phenotype
as risk factor, 6
association studies of, 18–20
mutation effects on, 16, 23
statistical estimation of, 15–16
Phenoxybenzamine
pharmacology of, 287–288, 289f
preoperative, for pheochromocytoma resection, 127
Phentolamine
intravenous, for hypertensive emergencies, 519,
521–522, 521t
pharmacology of, 287–288, 289f
Phenylalkylamines, pharmacology of, 268–269, 269f,
270t
Phenylephrine, hypertension related to, 145
Phenylpropanolamine
β-blocker combinations with, 236
hypertension related to, 146, 148
Pheochromocytoma
hypertension related to, 27t, 119–130
adrenal glands localization of, 119, 121f
clinical presentation of, 119
conditions that mimic, 119, 120t
diagnostic investigation of, 122–126
algorithm for, 124f
case finding for, 122–123
clonidine suppression test, 123
factitious, 124
localization studies, 121f, 124–126, 124f–127f
medications influencing, 123, 123t
renal failure and, 124
differential diagnosis of, 119, 120t
episodic, 123
extra-adrenal, 119
genetic testing for, 119–120, 129
genetics of, 119–122, 121t
in pregnancy, 130, 430
malignant, 129–130
metastatic lesions, 128–129
syndromic, 119–122, 121t
treatment of
algorithm for, 124f
surgical resection as, 126–129
acute hypertensive crises with, 128
anesthesia for, 128
long-term postoperative follow-up for,
128–129
preoperative management of, 126–128
hypertensive emergency with, 522
resistant hypertension related to, 501t, 503
Phlebotomy, for refractory hypertension, 147
Phosphodiesterase-5 inhibitors, 291
Phosphodiesterases, atrial natriuretic peptide and, 42
Phospholipase C, in α1-adrenoceptor activation, 287,
287f
Phosphorylation, in α1-adrenoceptor activation, 287, 287f
Photosensitivity dermatitis, diuretic-induced, 227
Physical activity. See Exercise/exercise programs.
Physical examination
for chronic disease management, 532
for hypertensive emergencies, 518
of children and adolescents, 447, 448, 560
Physician-patient partnership, for weight loss, 372
Physicians
adherence to clinical guidelines, 527, 532f, 567
integrated team role, 532–533, 532f
pharmacist collaboration with, 530
practice guidelines for. See Clinical practice
guidelines (CPGs).
visits to, as blood pressure control factor, 527, 532
Physiologic regulation, of blood pressure
in African Americans, hypertensive, 469–470, 469t
pathways for, 19, 19t
pharmacogenetic studies of, 20–21
Pinacidil, 299
Pindolol, 272t
elimination characteristics of, 234t
for peripheral arterial disease, 390
molecular structure of, 232, 235f
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
Pituitary gland
hyperplasia of, secondary, 150
in Cushing’s syndrome pathophysiology, 109–110
diagnosis of, 149
ectopic ACTH excess vs., 110
surgical resection of, 110, 149
PK. See Pharmacokinetics (PK).
PKD genes, 27t
Placebo control group, in new drug development,
540–541, 541f, 544
Placebo effect
cardiovascular death and, 162
cardiovascular endpoints and, 164
heart failure and, 163
home blood pressure monitoring and, 80
hypertension progression and, 165
in calcium channel blocker trials, 271, 272t, 273
in outcome studies, 309
ischemic heart disease and, 158–159
Index 605
Placebo effect (Continued)
isolated systolic hypertension and, 173
strokes and, 161
Placenta
blood flow in, with chronic hypertension, 432
perfusion alterations of, in preeclampsia, 430f, 435
Placental growth factor (PlGF), in preeclampsia, 430f, 435
Plasma renin activity (PRA)
acromegaly and, 150
angiotensin-converting enzyme inhibitors effects on,
242
diuretics effect on, 217, 217f
in African Americans, 469t, 470, 471
in hypertensive emergencies, 518
in primary aldosteronism, 110, 112f, 113t, 114f
in resistant hypertension, 501t, 502, 503
obesity and, 371–372, 371f, 379
renovascular hypertension and, 94, 98
sodium intake influence on, 203
Plasma volume (PV)
diuretics effect on, 217f, 218
in African Americans, 469t, 470
in preeclampsia, 436
in resistant hypertension, 504–505
transplant hypertension and, 364
Platelet count, in preeclampsia, 429, 430, 431, 435
PlGF (placental growth factor), in preeclampsia, 430f,
435
PNS (parasympathetic nervous system)
obstructive sleep apnea syndrome and, 137,
137f–138f, 140
vascular smooth muscle cell regulation by, 286
POISE (Perioperative Ischemic Evaluation) trial, 514
Polycystic kidney disease, 27t
Polymorphisms
association studies of, 18–20, 19t
in gene-diet interactions, 207
of β-adrenergic receptors, 234
pathophysiologic mechanisms of, 26–28
risk related to, 6, 42
single nucleotide, in human genome variations, 16
Polypharmacy
antihypertensive, prospective studies of, 10
pharmacogenetic studies of, 20–21
Polysomnography, 134, 560
ω-3 Polyunsaturated fatty acids
blood pressure response to, 206
supplementation with, 205
Pooling Project, 155
Popliteal artery, peripheral artery disease in, 385
Population attributable risk percent, 3
of cardiovascular disease, 7, 9f, 10
Population studies
ethnic subgroups in. See Race/ethnicity; specific
ethnicity, e.g., African Americans.
for new drug development, 539
selection of, 542
of home blood pressure monitoring, 72
normal limits in, 74, 76, 76t
sample size for, 81
of potassium intake increase, 203–204, 204f
on coronary heart disease risk, 195–196
on diuretics, 219, 222, 222f
on genetics
admixture, 17, 20, 21f, 482
geographical, 21–22
racial, 16, 17, 18, 21–22
stratification influence, 17
on mortality, 58, 155. See also specific disease,
e.g. Ischemic heart disease.
on obstructive sleep apnea syndrome, 135–136
on sodium intake reduction, 202–203, 203f
Porphyria, resistant hypertension related to, 500f, 504
Positron emission tomography (PET) scan, for
pheochromocytoma localization, 126, 126f
Post-myocardial infarction status, angiotensin-
converting enzyme inhibitors for, 239, 240,
240t, 242, 243
end-organ effects and, 247
Post-Stroke Antihypertensive Treatment Study (PATS),
159f, 161f, 162f
East Asians in, 398, 398f, 490
Post-transplant lymphoproliferative disease, 348
Postmenopausal Estrogen/Progestin Intervention
(PEPI) trial, 465
606 Index
Postmenopausal patients, dyslipidemia treatment for, 423
Postoperative hypertension, 512–515. See also
Perioperative hypertension.
Postoperative hypotension, with pheochromocytoma
resection, 128
Postpartum counseling, on preeclampsia, 437–438, 438f
Postural hypotension
angiotensin-converting enzyme inhibitors and, 242
in elderly patients, 458, 463
Potassium, reabsorption of, diuretic therapy impact on,
213, 214f
adaptive changes to, 223–225, 224f
Potassium balance/imbalance
aldosterone role in, 39–40
angiotensin-converting enzyme inhibitors and, 246,
249
angiotensin II receptor blockers causing, 264
CHEP 6 guidelines for, 564, 565
common drugs influencing, 204
in ectopic ACTH syndrome, 109–110
in primary aldosteronism, 110, 111f–112f, 112t, 113t
diagnostic applications of, 113, 114f
therapeutic considerations, 114–115, 115f
in resistant hypertension, 501t, 502
transplant hypertension and, 364, 365
with mineralocorticoid excess states, 106, 107f, 107t,
108
Potassium channel openers, new investigations on, 299
Potassium channels, adenosine triphosphate (ATP)-
sensitive, activation of, 299
Potassium intake, dietary
CHEP 6 guidelines for, 564
for children and adolescents, 449–450, 449f
in African Americans, 470, 477
increased, blood pressure response to, 203–204, 204f
risk related to, 6
weight loss targets for, 372, 373t
Potassium-sparing diuretics, distal, 215–216
combination therapy with, 224–225
nephron sites of action, 213, 214f
pharmacokinetics of, 213, 214t
Potassium supplementation
diuretic therapy indications for, 224, 225
postoperative, for primary aldosteronism, 115
Potassium-wasting
diuretic-induced, transplant hypertension and, 364,
365
in renal disorders, mineralocorticoid-dependent,
106, 107f, 107t
PP. See Pulse pressure (PP).
PPARγ (peroxisome proliferator-activated receptor γ),
mutations in, 17t
PRA. See Plasma renin activity (PRA).
Pravastatin, 355
drug interactions with, 420, 420t
Prazosin, 288
for children and adolescents, 450, 453t
for diabetes-related hypertension, 413
pharmacology of, 288, 289f
Precapillary vessels, peripheral resistance determined
by, 33
Precocious puberty, with adrenocortical enzyme
deficiency, 107, 108
Preeclampsia, 435–438
blood pressure changes with, 435
cardiac function and, 436
central nervous system and, 436
clinical features of, 429, 435
diagnosis of, 435
eclampsia in, 429, 436
fms-like tyrosine kinase role, 430t, 435
HELLP syndrome variant of, 429, 435, 436, 437
hypertensive emergency with, 517, 518, 518t, 522
management of, 437–438
nonpharmacologic, 432
pharmacologic, 436, 437t
timing of fetal delivery, 436
maternal syndrome with, 435–436
metabolic disturbances with, 435–436
outcome risks with, 431, 436
pathophysiology of, 435–436
placental perfusion alterations with, 430f, 435
postpartum counseling on, 437–438, 438f
prevention of, 432, 435
renal changes with, 436
Preeclampsia (Continued)
risk factors for, 429, 430t, 435
superimposed on chronic hypertension, 429
Pregnancy
blood pressure lability during, 435, 437
chronic hypertension during, 429–435
characteristics of, 429
differential diagnosis of, 429–431, 430f
fetal risks with, 431
management of, 431–435
nonpharmacologic, 432
pharmacologic, 432–435
preconception, 431–432
preeclampsia prevention, 432
maternal risks with, 430–431
pharmacologic management of, 432–435, 433t
α-adrenergic blockers, 433
β-adrenergic blockers, 234, 432–433
angiotensin-converting enzyme inhibitors,
248–249, 431, 434–435
angiotensin II receptor blockers, 431, 434
calcium channel blockers, 281, 433–434
central adrenergic agonists, 432
diuretics, 434
FDA classification of, 432
initiation parameters for, 432
serotonin2-receptor blockers, 434
vasodilators, 434
preeclampsia superimposed on, 429
drugs harmful to fetus during. See Teratogens.
future, counseling for, 437
gestational hypertension in, 429, 431
habitual snoring during, 136
hypertensive disorders in, 429–438
chronic, 429–435
classification of, 429–438
complications of, 429, 438
consultations for, 429
diagnostic algorithm for, 430f
exacerbated, 17t, 27t, 28f
gestational, 429
incidence of, 429
lactation and, 438
postpartum follow-up on, 431f, 438
preeclampsia-eclampsia, 429, 435–438
preeclampsia superimposed on chronic, 429
secondary, 430, 437, 431f
white-coat hypertension vs., 430
new drug development and, 537
pheochromocytoma in, 130, 430
preeclampsia in, 435–438. See also Preeclampsia.
Prehypertension
definition of, 6–7, 7t, 166
evolving classifications for, 53–54, 54t
in children, 440
WGTF 4 guidelines for, 558, 559t
international guidelines for, 566
comparisons of, 572–573
JNC 7 guidelines for, 554t, 555
natural history of, 155, 156f, 165–166
prevalence of, 217
preventive measures for, 166
Preload, cardiac, obesity and, 372
Premature delivery
in African Americans, 472
pregnancy-related hypertension and, 431
PREMIER trial, on weight loss, 374–375, 377t
African Americans in, 474
Prescription drug(s)
Medicare benefit for, 529
therapeutic use of. See Pharmacotherapy.
Prescription Drug User Fee Act (PDUFA) of 1992, 538
Pressure waveform, reflection of, in isolated systolic
hypertension, 36, 172
Prevalence, of hypertension, 3, 217
by race/ethnicity, 4, 4t
by sex, 4, 4t
in U.S., 3–4, 4f, 4t
PREVEND IT (Prevention of Renal and Vascular
Endstage Disease Intervention Trial), 355
PREVENT (Prospective Randomized Evaluation of the
Vascular Effects of Norvasc Trial), 278–279,
278t, 319t
Prevention of Atherosclerosis with Ramipril Trial no. 2
(PART2), 159f, 319t
Prevention of Atherosclerotic Complications with
Ketanserin (PACK) study, 387
Prevention of Events with Angiotensin-Converting
Enzyme Inhibition (PEACE), 159f, 162, 243,
244, 411t, 414
Prevention of Renal and Vascular Endstage Disease
Intervention Trial (PREVEND IT), 355
Preventive measures. See specific disease, e.g.,
Prehypertension.
Preventive Services Task Force, U.S. (USPSTF), 552
Primary aldosteronism
adenoma vs. hyperplasia differentiation, 112–113,
148, 149
clinical recognition of, 110
diagnosis of, 110, 112f, 112t, 113t
simplified approach to, 113, 114f
hypertension related to, 107t, 110–115
in African Americans, 469, 469t, 470
in resistant hypertension, 500f, 501t, 502–503
localizing procedures for, 113, 114f
screening tests for, 110, 111f–112f, 113t, 502
therapeutic choices for, 113–115, 114f–115f
Primary stroke, 394
prevention by blood pressure lowering, 394–397
Procedures, for clinical trials, 312–313
Professional organizations/societies, representation in
education program, 552, 552t–553t
Progestin, oral, hypertension related to, 145
Prognostic value
of blood pressure monitoring
ambulatory, 86, 87f
in home, 77
of obstructive sleep apnea syndrome, 139
PROGRESS. See Perindopril Protection against
Recurrent Stroke Study (PROGRESS).
Propranolol
elimination characteristics of, 234t
for children and adolescents, 450, 452t
for peripheral arterial disease, 389
historical studies on, 306
molecular structure of, 232, 235f
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
Prorenin, description of, 37, 37f
Prospective Randomized Evaluation of the Vascular
Effects of Norvasc Trial (PREVENT), 278–279,
278t, 319t
Prospective Studies Collaboration, 12
cardiovascular disease findings, 51f–52f, 161, 172
mortality data of, 155–156
prehypertension findings, 166
stroke findings, 160, 160f
Prostacyclin, angiotensin-converting enzyme inhibitors
effects on, 241
Prostaglandins
angiotensin-converting enzyme inhibitors effects on,
241
mediating role of, 26f
renal synthesis of, diuretic therapy impact on, 213,
217
Prostaglandin E2, diuretic therapy impact on, 213
Prostatic hyperplasia, benign, α1-adrenoceptor
antagonists and, 286, 288, 291
Protein(s)
angiogenic, in preeclampsia, 430f, 435
binding of β-adrenergic blockers, 233t
Protein intake, dietary
blood pressure response to, 206–207
for weight loss, 372, 373t
restriction of, angiotensin-converting enzyme
inhibitors and, 246
Protein kinase
cyclic guanosine monophosphate–dependent,
vascular tone and, 33, 34f
mitogen-activated, in angiotensin II–converting
enzyme mediation, 38–39, 38f
Protein kinase C, in α1-adrenoceptor activation, 287,
287f
Proteinuria
angiotensin-converting enzyme inhibitors and, 244,
245, 245f
angiotensin II receptor blockers reduction of,
257–258
coronary heart disease risk and, 195
diabetes mellitus and, 409

Proteinuria (Continued)
in chronic kidney disease, 186, 353–354, 353f
hypertension management and, 357–358
treatment goals for, 355–356
in end-stage renal disease, 163–164, 163f
in preeclampsia, 430, 431, 435, 436
in untreated hypertension, 156f, 165
loop diuretics and, 214
transplant hypertension and, 366
Proximal tubule, diuretics action in, 213, 214f, 214t
Pseudoephedrine
β-blocker combinations with, 236
hypertension related to, 146
Pseudohypertension, 144
in elderly patients, 458
resistant hypertension vs., 499
Pseudohypoaldosteronism type 1 (PHA1), dominant vs.
recessive, 17t, 27t, 28f
Psychological disorders
pheochromocytoma vs., 119, 120t
resistant hypertension related to, 500f, 504
Psychosocial factors, in African Americans, 470
Psychotropic drugs, resistant hypertension related to,
508, 508t
Public education. See also National High Blood Pressure
Education Program (NHBPEP).
for Hispanics, 485
Public health
in Hispanic communities, 485
obstructive sleep apnea and, 141
Public Health Service Cooperative Study, U.S., on
adverse clinical events, 159, 164
Public perception, of clinical trials, 313
PubMed, genetic data in, 18
Puerto Ricans. See Hispanics.
Pulmonary capillary wedge pressure, preeclampsia and,
436
Pulmonary edema
“flash,” 181
hypertensive emergency with, 517, 518, 518t
management of, 519, 521
in preeclampsia, 436
renovascular hypertension and, 95
Pulmonary hypertension, as heart transplant
contraindication, 347, 347t
Pulsatile stress, cerebral function and, 170
Pulse deficits, in hypertensive emergencies, 518
Pulse pressure (PP)
age factor of, 5, 169, 170f, 328, 330f
arterial stiffness impact on, 36
assessment of, 182
cardiovascular disease risk and, 11–12, 50, 51, 328
blood pressure assessment in, 171, 171f
diagnostic caveats for, 172–173
meta-analysis of, 169–170, 170f
systolic blood pressure importance, 8–9, 9t
definition of, 5, 11, 169
in elderly patients, 457–458
in peripheral artery disease, 387
left ventricular hypertrophy and, 179, 334
Pulse wave velocity (PWV)
arterial stiffness impact on, 36, 172
assessment of, 182, 327, 329f
left ventricular hypertrophy and, 179
PURAS study, of home blood pressure monitoring, 74
Pure motor hemiparesis, 183
PV. See Plasma volume (PV).
PVR. See Peripheral vascular resistance (PVR).
PWV. See Pulse wave velocity (PWV).
Pyelonephritis, in adolescents, 446
Quality assurance/improvement
for blood pressure measurement
critical skills for, 60, 60f
cuff application accuracy, 62–63, 62f, 62t
equipment inspection guidelines, 66
historical perspective of, 58
manometer calibration in, 60–61, 60f
measuring technique in, 63–64
proper technique for, 60–64
reading accuracy, 63, 63f
stethoscope use and, 61–62
for clinical trials, 312–313
QUIET (Quinapril Ischemic Events Trial), 159f, 319t
Quinapril
chronotherapeutic treatment of, 89–90, 90t
clinical trials on, 246
for hypertension, 240t
in African Americans, 468, 469f, 475
in children and adolescents, 450, 451t
Quinapril Ischemic Events Trial (QUIET), 159f, 319t
Quinidine, post-heart transplant indications for, 347
Quintirole, 296
r-HuEPO (recombinant human erythropoietin),
hypertension related to, 146–147
R-hypertensives, 518
RAAS. See Renin-angiotensin-aldosterone system
(RAAS).
Race/ethnicity. See also specific ethnicity, e.g. Hispanics.
as risk factor, 6, 58
cardiovascular death trends based on, 161, 162f
genetic studies on, 16, 17, 19t, 21–22
admixture mapping, 17, 20, 21f, 482
global cardiovascular risk and, 192
home blood pressure monitoring and, 80
hypertension definition based on, 49–50, 50f
increased sympathetic response related to, 33
low birth weight related to, 472
mortality data and, 156, 161
obstructive sleep apnea syndrome and, 136t
peripheral artery disease prevalence based on, 384
prevalence trends based on, 4, 4t
stroke risk related to, 394, 395f, 396
transplant hypertension and, 363–364
Radial artery, blood pressure measurement and, 64, 66
in elderly, 144
Radiation therapy
for ACTH-producing tumors, 110
for pituitary tumors, 149
Radiofrequency ablation, for metastatic
pheochromocytoma, 129
Radiography, chest
for children and adolescents, 448
for heart failure assessment, 179t, 181
aging impact on, 341
for hypertensive emergencies, 518
Radioimmunoassay, for hypercortisolism diagnosis,
109–110
RALES (Randomized Aldactone Evaluation Study), 344
Ramipril, 240t
clinical trials on, 159f, 243, 244, 245, 246, 248
for African Americans, 476
for chronic kidney disease, 353t, 356
for diabetes-related hypertension, 410, 411t, 414
for peripheral arterial disease, 389
for ST-segment elevation myocardial infarction, 337
for transplant hypertension, 365t, 366
pharmacology of, 239
Ramipril Efficacy in Nephropathy (REIN) study, 245,
353t, 356, 357
Random-effects model, for meta-analyses, 316
Randomization, in outcome studies, 307
Randomized Aldactone Evaluation Study (RALES), 344
Randomized Evaluation of Mechanical Assistance for
the Treatment of Congestive Heart Failure
(REMATCH), 346
Randomized Evaluation of Strategies for Left
Ventricular Dysfunction (RESOLVD), 258,
259f, 261
Randomized trials
on antihypertensive drugs. See specific agent or trial.
with clinical endpoints. See Outcome study(ies).
Randomized withdrawal study, of new drugs, 541f, 542
RAS. See Renin-angiotensin system (RAS).
Raynaud’s phenomenon, α1-adrenoceptor antagonists
for, 288, 292
RBF. See Renal blood flow (RBF).
RDI (respiratory disturbance index), in sleep disorders,
134
Reactive airway disease, β-adrenergic blockers use with,
236
Reactive oxygen species
angiotensin II and, 39
essential hypertension role of, 34, 35f
vascular remodeling and, 38f, 39, 39f
Index 607
Receptor-operated channels, of calcium pump, 268, 269f
Recombinant human erythropoietin (r-HuEPO),
hypertension related to, 146–147
Reconstructive Endoventricular Surgery Returning
Torsion Original Radius Elliptical Shape to the
Left Ventricle (RESTORE), 346
Reconstructive surgery
for coarctation of the aorta, 148
on mitral valve, for heart failure, 345–346
Recurrent stroke, 394
prevention by blood pressure lowering, 397–398,
398f
Reduction of Endpoints in Non–Insulin Dependent
Diabetes Mellitus with the Angiotensin II
Antagonist Losartan trial (RENAAL), 159f, 258,
259f, 260, 319t, 322
chronic kidney disease in, 353t, 354f, 356, 357
in meta-analysis, 411t, 412
Reflex control, inhibitory vs. stimulatory, of blood
pressure, 29–30, 30f, 31f
Refractory hypertension, 498–509. See also Resistant
hypertension.
fluid removal for, 147
obstructive sleep apnea syndrome and, 135
phlebotomy for, 147
Registration, of clinical trials, 312–313
Regulatory authorities, environmental concerns about
mercury in workplace, 58–59
Regulatory development, of antihypertensive drugs,
535–546
ambulatory blood pressure monitoring in, 543
clinical efficacy in, 540–543, 541f
clinical pharmacology in, 538–540
dose interval in, 542
dose selection in, 542
dose titration in, 542–543
drug-drug interactions and, 537, 539, 545
effectiveness criteria, 535, 540
endpoints for, 535, 543, 546
exclusivity criteria, 546
FDA role, 535, 537–538, 543, 546
food effects and absorption in, 539
for fixed-combinations, 544, 544f
metabolism and elimination in, 539
outcome labeling claims and, 543–544
overview of, 536–538
pediatric patients and, 546
pharmacodynamics in, 539–540
pharmacokinetics in, 537, 538–539
safety in, 535, 537, 545–546
special populations and, 539
study designs for, 540–542, 541f
study populations for, 542
terminology for, 535
Web addresses for, 536, 536t
REIN (Ramipril Efficacy in Nephropathy) study, 245,
353t, 356, 357
Rejection. See Organ rejection.
Relapse prevention model, for dietary changes, 207
Relative risk
of cardiovascular disease, 7, 8f, 11f
of hypertension, 3
Relaxation strategies, for blood pressure measurement,
63
Reliability, of blood pressure measurement, 64–66
standardized monitoring of, 64, 65f
REMATCH (Randomized Evaluation of Mechanical
Assistance for the Treatment of Congestive
Heart Failure), 346
RENAAL. See Reduction of Endpoints in Non–Insulin
Dependent Diabetes Mellitus with the
Angiotensin II Antagonist Losartan trial
(RENAAL).
Renal angiography
“drive-by,” 100–101
for renovascular hypertension, 95, 95f, 96–97
performance characteristics of, 97, 100–101
resistant, 501t, 502
intra-aortic, 100
intravenous digital subtraction, 100
Renal angioplasty, for renovascular hypertension, 94,
101–102
clinical trials on, 102–103
resistant, 501t, 502
stenting plus, 102
608 Index
Renal arteriopathy
in African Americans
pressure-related mechanisms of, 173f, 472–474
with prematurity, 472
in resistant hypertension, 509
atherosclerotic, 500–502, 501t
uric acid and, 35–36
Renal artery
aneurysms of, renovascular hypertension with, 94
in pheochromocytoma resection, 128
stenosis of
Goldblatt model of, 94–95
in African Americans, 469
in infants and children, 446
in resistant hypertension, 502
renovascular hypertension vs., 93
screening tests for, 96–97
transplant hypertension and, 364
thrombosis of, in infants, 446
Renal blood flow (RBF)
angiotensin-converting enzyme inhibitors effects on,
248–249, 249f
calcineurin inhibitors impact on, 361
chronic kidney disease and, 186
diuretics effect on, 224f
transplant hypertension and, 361, 366
Renal cell carcinoma, diuretic-induced, 227
Renal disease. See Kidney disease.
Renal failure
diabetes mellitus and, 406, 407, 408f
diuretics and, 213, 214t, 217, 227
hypertension risk for, 7
in elderly patients, 457
in untreated hypertension, 163–164, 163f
pathophysiology of, 32–33
pheochromocytoma and, 124
Renal function/dysfunction
angiotensin-converting enzyme inhibitors effects on,
241t, 243
calcium channel blockers effects on, 277, 277f
obesity and, 370, 371f, 378
organ transplantation impact on, 361–362
creatinine marker of, 364
primary mediators of, 363–364
potassium excretion factors, 204
preeclampsia management based on, 436
sodium excretion factors, 203
Renal insufficiency
angiotensin-converting enzyme inhibitors and,
248–249, 249f
in untreated hypertension, 164
Renal parenchymal disease
in children, 446, 446t, 448
resistant hypertension related to, 499, 500, 500f, 501t
Renal potassium-wasting disorders, mineralocorticoid-
dependent, 106, 107f, 107t
Renal scintigraphy, for renovascular hypertension, 98
captopril contrast, 95–96, 97f
performance characteristics of, 97t, 98–99
Renin
description of, 37, 37f
plasma. See Plasma renin activity (PRA).
secretion of
as pathophysiologic factor, 36, 37
sympathetic nervous system modulation by, 30, 30f
Renin-angiotensin-aldosterone system (RAAS)
acromegaly and, 150
angiotensin-converting enzyme inhibitors effects on,
242, 243
diabetes and, 244, 244f
renal mechanisms of, 246, 246t
angiotensin II role in, 37–39, 37f–39f
angiotensin I vs., 37–38
as pathophysiologic factor, 37–39, 37f
autonomic nervous system interactions with, 29, 30f
diabetes mellitus and, 408, 409, 409f
treatment considerations of, 410, 411, 414
diagram of, 299, 300f
diuretics effect on, 216, 217, 222, 223, 226
braking phenomenon and, 216
candidate genes of, 19t, 26–28
circadian influences on, 89
essential hypertension role of, 34, 35, 35f
kallikrein-kinin system relationship to, 42–43
natriuretic peptides modulation of, 41, 41f–42f
Renin-angiotensin-aldosterone system (RAAS)
(Continued)
obstructive sleep apnea syndrome and, 138, 138f, 140
schematic representation of, 37, 37f
sodium intake influence on, 203, 207
heart failure and, 340, 341
in kidney disease, 351–352, 356, 357
inhibition of, for hypertension, 299
obesity and, 371–372, 371f, 378, 379
vascular smooth muscle cell regulation by, 286
Renin-angiotensin system (RAS)
atherogenesis promotion by, 419, 419f
blockade of
for African Americans, 476–477, 479
in resistant hypertension, 505f, 506
gene association studies on, 18, 19, 19t
in African Americans, 469t, 470–471
obesity and, 477
renal injury mechanisms and, 473–474, 473f
therapeutic intervention for, 476–477, 479
in perioperative hypertension, 514
pharmacogenetic studies of, 20–21
Renin-angiotensin system antagonists
for African Americans, hypertensive, 476–477
optimal use of, 479
for resistant hypertension, 505f, 506
Renin inhibitors, new investigations on, 299–300, 300f
Renogram, captopril, for resistant hypertension, 502
Renovascular hypertension, 93–103
absolute risk of
clinical prediction rule for, 95, 96t
estimation for, 95, 95f
clinical trials on therapies, 102–103
angioplasty vs. medical management, 102–103
surgery vs. angioplasty, 102
surgery vs. medical management, 102
diagnostic evaluation of, 95–101
algorithms for, 95, 95f
risk estimations, 95, 95f, 96t
screening tests, 95–98
older, 97–98
sensitive, 95–97
Goldblatt model of, 94–95
initial risk estimation for, 95, 95f
pathophysiology of, 94–95
prevalence of, 93
estimates of, 94
primary hypertension vs., 95, 96t
renal artery stenosis vs., 93, 94
resistant, 499, 500–502, 500f, 501t
risk factors of, 94
subtypes of, 93–94
atherosclerotic disease, 94
fibromuscular dysplasia, 93–94
other less common, 94
therapy for, 101–102
angioplasty, 101–102
clinical trials on, 102–103
stenting plus, 102
medical management, 102
clinical trials on, 102–103
resistance to, 94
meta-analyses of, 102–103
surgical revascularization, 101, 101t
clinical trials on, 102
Reproducibility, of blood pressure measurement
ambulatory, 85, 86f, 89
in home, 71–72
in office, 64–66
standardized form for, 64, 65f
Research
funding sources for, 60
genetic
context of, 15, 23
study designs for, 16–17
outcome-based. See Outcome study(ies).
trial-based. See Clinical trials.
Resection. See Surgical resection.
Reserpine, 305, 475
Resistant hypertension, 498–509
blood pressure measurement in, 499
classification of, 499, 499t
common reasons for, 527
Cushing’s syndrome and, 106, 107t, 108
definition of, 498
Resistant hypertension (Continued)
differential diagnosis of, 499–509, 500f
future directions for, 509
in children and adolescents, 558
inappropriate/inadequate medical treatment in, 499t,
504–506
dietary approaches to, 504, 504t
diuretic treatment importance in, 504–505
lifestyle approaches to, 504, 504t
physician inertia and, 506, 509
rational multidrug program for, 505–506, 505f
reasons for, 504, 504t
interfering exogenous substances in, 499t, 507–508
metabolic syndrome in, 499t, 508–509
obesity and, 499t, 508–509
obstructive sleep apnea syndrome and, 135
office, 499, 500f
patient nonadherence to treatment, 499t, 506–507, 509
prevalence of, 498–499
prognosis with, 509
pseudohypertension vs., 499
secondary, 499–504, 500f, 501t
specific identifiable disorders in, 499–504, 500f
Cushing’s syndrome, 503
pheochromocytoma, 503
primary aldosteronism, 502–503
rare, 500f, 504
renal parenchymal disease, 499, 500
renovascular disease, 499, 500–502
sleep disorders, 503
thyroid disorders, 503
vascular disorders, 504
systolic, 498, 499
isolated, in elderly, 499t, 507, 509
treatment of
α-adrenergic blockers in, 506
β-adrenergic blockers in, 502, 506
algorithm for, 499, 500f
angiotensin-converting enzyme inhibitors in, 500,
501t, 502, 503, 508, 509
in multidrug program, 505–506, 505f
angiotensin II receptor blockers in, 501, 501t, 502,
503, 507, 509
in multidrug program, 505–506, 505f
blood pressure goals for, 498
calcium channel blockers in, 501t, 502, 503,
507–509
in multidrug program, 505–506, 505f
DASH diet for, 500f, 504, 504t
diuretics in, 500, 501t, 503, 506, 507, 509
importance of, 504–505, 505f
lifestyle modifications for, 504, 504t
renin-angiotensin system antagonists in, 505f, 506
vasodilators in, 505f, 506
volume regulation for, 500
white-coat hypertension vs., 499
RESOLVD (Randomized Evaluation of Strategies for
Left Ventricular Dysfunction), 258, 259f, 261
Respiration(s), sleep physiology and, 134
apnea, 134–141, 136t. See also Sleep apnea.
restarting of, 136, 137, 137f
Respiratory distress syndrome, in infants, 446
Respiratory disturbance index (RDI), in sleep disorders,
134
RESTORE (Reconstructive Endoventricular Surgery
Returning Torsion Original Radius Elliptical
Shape to the Left Ventricle), 346
Resynchronization therapy, for heart failure, 344–345
RET proto-oncogene, 27t
secondary hypertension related to, 120–121, 121t
Retesting programs, for blood pressure measurement,
59–60, 59f
Retinal vascular changes, in hypertensive retinopathy,
184–185, 185t
Retinopathy
diabetic, 407, 408f
angiotensin-converting enzyme inhibitors effect
on, 244
hypertensive
assessment of, 184–185, 185t
Keith-Wagener-Barker classification of, 157
natural history of, 156f, 157, 165
Retraining programs, for blood pressure measurement,
59–60, 59f
Revascularization. See Surgical revascularization.

Rho/Rho kinase, vascular tone and, 33, 34, 34f SAVE (Survival and Ventricular Enlargement) trial, 336,
Ribonucleic acid (RNA), messenger, angiotensin II and, 343
39 SBP. See Systolic blood pressure (SBP).
Right ventricle, cardiac, in heart failure, 341 SCAT (Simvastatin/Enalapril Coronary Atherosclerosis
Rilmenidine, 297f, 298, 298t Trial), 319t
Rimonabant, 299 Schoenfeld approach, to outcome studies, 311
Risk factors, for hypertension, 5–6. See also specific risk. Scintigraphy
age as, 5, 5f, 190, 192, 193f captopril, for renovascular hypertension, 95–96, 97f
blood pressure as, 190–191 performance characteristics of, 97t, 98–99
spectrum of, 10–11, 11f fluoride-18-fluorodeoxyglucose, for
clustering of, 12, 12f pheochromocytoma localization, 126, 126f
diabetes mellitus as, 7, 8f–9f, 191–192 for renovascular hypertension, 98
gender as, 8, 8f–9f, 190, 192, 193f iodine-123-meta-iodobenzylguanidine, for
global cardiovascular risk and, 190–196 pheochromocytoma localization, 124f,
in older individuals, 13 125–126, 126f
lipids as, 190 malignant, 129
smoking as, 191 SCNN1A gene, 19, 19t, 27t
weight as, 5–6 SCNN1B gene, 19, 19t
Risk reduction, case management for, 527–528 SCNN1G gene, 19, 19t, 27t
Risk stratification SCOPE. See Study on Cognition and Prognosis in the
for isolated systolic hypertension, 166, 169–175. See Elderly (SCOPE).
also Isolated systolic hypertension (ISH). SCORE Project, 193
for renovascular hypertension, 95, 95f Scorpion venom, hypertension related to, 148
for untreated hypertension, 155–166. See also Screening tests
Untreated hypertension. for adolescent drug use, 560
genetic research and, 23 for Cushing’s syndrome, 109, 149
in cardiovascular risk for dyslipidemia, 424
global prediction and, 190–196. See also Global for hypercortisolism, 109–110, 149
epidemiology. for hypertension
total, international comparisons of, 573 criteria for, 53
target organ damage assessment for, 178–187. See in clinical trials, 313
also Target organ damage (TOD). in Hispanic communities, 485
RNA (ribonucleic acid), messenger, angiotensin II and, for obstructive sleep apnea, 135
39 for primary aldosteronism, 110, 111f–112f, 113t, 502
ROMK gene, 27t SDB (sleep-disordered breathing) syndromes, 134, 135t
Ropinirole, 296 epidemiology of, 134–135, 136t
Rostral ventrolateral nucleus of the medulla oblongata SDD. See Standard deviation of the difference (SDD).
(RVLM) SDH gene, secondary hypertension related to, 122, 129
imidazoline agonists effects on, 297f SDHB gene, 27t
sympathetic activity of, 29, 30–31, 31f SDHD gene, 27t
“Rule of 10,” for pheochromocytoma characteristics, Season of year, home blood pressure monitoring and,
119 73, 73t
RVLM (rostral ventrolateral nucleus of the medulla Seated position, for blood pressure measurement, 63,
oblongata) 63f
imidazoline agonists effects on, 297f Secondary hypertension
sympathetic activity of, 29, 30–31, 31f guidelines for, international comparisons of, 571
in African Americans, 469
in children, 560
acute vs. chronic, 446t
Safety causes of, 441, 446
hyperparathyroidism considerations for, 150 in elderly patients, 458
in new drug development, 535, 537, 545–546 in pregnancy, 430, 437, 438f
of calcium channel blockers, 273, 274t, 275, 275f mineralocorticoid excess and, 106–116. See also
Salivary glands, imidazoline agonists effects on, 297f Mineralocorticoid excess states.
Salt appetite, aldosterone role in, 39–40 pheochromocytoma in, 119–130. See also
Salt-ingestion suppression testing, for primary Pheochromocytoma.
aldosteronism, 502 renovascular, 93–103. See also Renovascular
Salt intake. See Sodium intake. hypertension.
Salt loading resistant, 499–504, 500f, 501t
effect on serum potassium, 110, 111f Cushing’s syndrome in, 503
for aldosteronism diagnosis, 113, 114f pheochromocytoma in, 503
Salt-loading test, outpatient oral, protocol for, 110, 112t, primary aldosteronism in, 502–503
113 rare causes of, 500f, 504
Salt restriction. See Sodium restriction. renal parenchymal disease in, 499, 500
Salt retention. See Sodium retention. renovascular disease in, 499, 500–502
Salt-sensitive hypertension sleep disorders in, 503
angiotensin-converting enzyme inhibitors effects on, thyroid disorders in, 503
241 vascular disorders in, 504
anterior hypothalamic area in, 31–32, 32f sleep apnea and, 134–141. See also Sleep apnea.
Salt-sensitivity Secondary sex characteristics, with mineralocorticoid
definition of, 204, 204f excess states, 106, 107–108
in African Americans, 469t, 471–472 Secondary stroke, 394
therapeutic considerations for, 477 prevention by blood pressure lowering, 397–398,
Sampatrilat, 298 398f
SAMPLE (Study on Ambulatory Monitoring of Blood Secular trends, of hypertension
Pressure and Lisinopril Evaluation), 80 by race/ethnicity, 4, 4t
Sample power, in outcome studies, 311–312, 312t by sex, 4, 4t
Sample size in U.S., 3–4, 4f, 4t
home blood pressure monitoring and, 81 Segregation analysis, 16
in outcome studies, 311–312, 312t Seizures
San Luis Valley Diabetes Study, 387 in children, 561
Sartan drugs. See also Named drug, e.g., Telmisartan. pregnancy-related, 429, 436
pharmacologic properties of, 254–257, 255t β1-Selective adrenergic blocking agents, 231, 232t
SASs. See Sleep apnea syndromes (SASs). Self-applied behavior modification, for dietary changes,
Saturated fat intake, blood pressure response to, 206 207
Index 609
Self-monitoring of blood pressure. See Home blood
pressure monitoring (HBPM).
Sensory skills
for blood pressure measurement, 60, 60f
loss of, in stroke syndromes, 183
Sequelae, with hypertension, 7–12. See also specific disease.
cardiovascular disease as, 7–8, 8f
pulse pressure and, 8–9, 9t, 11–12
death as. See Mortality.
“mild” range importance, 10–11, 11f
renal disease as, 3, 7, 12
untreated, 155–166. See also Untreated hypertension.
Serotonin receptor agonists
hypertension related to, 146
new investigations on, 298
Serotonin reuptake inhibitors, blood pressure response
to, 377–378
Serotonin2-receptor blockers, for pregnancy-related
hypertension, 433t, 434
Seven Countries Study, 496
Seventh Report. See Joint National Committee (JNC),
Seventh Report of (JNC 7).
Severe hypertension
CHEP 6 guidelines for, 561, 563t, 565f
evolving classifications for, 53–54, 54t
Sevoflurane, hypertension related to, 145
Sex. See Gender.
Sex hormones
adrenocortical enzyme deficiency impact on,
106–108, 108f
hypertension related to, 145
Sexual dysfunction, diuretic-induced, 227
Shanghai Trial of Nifedipine in the Elderly (STONE),
161f, 272t
SHARE (Study of Health Assessment and Risk in Ethnic
Groups), 496
SHELL study, 272t, 319t
SHEP. See Systolic Hypertension in the Elderly Program
(SHEP) trial.
SHR (spontaneously hypertensive rat), sympathetic
nervous system of, 31, 32
Sibutramine
blood pressure response to, 377–378
hypertension related to, 145–146
Sibutramine Trial on Obesity Reduction and
Maintenance (STORM), 378
Sick sinus syndrome
β-blocker cautions with, 236
pacemaker indications for, 345
Signal transduction pathway, of G-protein, candidate
genes of, 19, 19t, 21
Signaling pathway, for natriuretic peptides, therapeutic
exploitation of, 42
Sildenafil, 42
“Silent killer,” 485
Simvastatin/Enalapril Coronary Atherosclerosis Trial
(SCAT), 319t
Single-chamber pacing, for heart failure, 345
Single nucleotide polymorphisms (SNPs)
association studies of, 18–20
distribution patterns of, 16
in human genome variations, 16
pharmacogenetic studies of, 20–21
Sinus node, heart transplant and, 347
Sirolimus, transplant hypertension and, 362
Sixth Report of Joint National Committee, 572
Skeletal muscle, chemoreceptors in, 30, 30f–32f
SKP-450, for hypertension, 299
Sleep, physiologic mechanisms of, 134
Sleep apnea, 134–141
acromegaly and, 150
central, 134, 135t
definitions for, 134, 135t
diagnosis of, 134
mixed, 134, 135t
obstructive, 134–141. See also Obstructive sleep
apnea syndrome (OSAS).
Sleep apnea syndromes (SASs), 134–141, 135t
heart failure associated with, 181
obesity and, 371f, 372
Sleep-disordered breathing (SDB) syndromes, 134, 135t
epidemiology of, 134–135, 136t
Sleep history, 135, 141
Sleep hypoventilation syndrome, 134, 135t
Sleep study, 135, 560
610 Index
Small arteries, 181, 182
Small cell lung carcinoma, 148
Small vessel disease, stroke related to, 392, 393f, 400
Smoking. See Cigarette smoking.
Smooth muscle
innervation of, 286–287, 287f
vascular. See Vascular smooth muscle cells (VSMCs).
SMS 201-995 (octreotide), for ACTH-producing
tumors, 110
SNPs. See Single nucleotide polymorphisms (SNPs).
SNS. See Sympathetic nervous system (SNS).
SOC (standard of care), in outcome studies, 309–310,
309f
Social cognitive theory, for dietary changes, 207
Society of Obstetrics and Gynecology of Canada,
552–553
Sociocultural issues
in Hispanics, 483, 485
in South Asians, 495–496
of patient adherence, 527
Sociodemographics
of Hispanics, 483, 484
of South Asians, 495
Sodium, reabsorption of
diuretic therapy impact on, 213, 214f, 215, 216
adaptive changes to, 223, 224f
obesity and, 370, 371f, 378
Sodium balance/imbalance
acromegaly and, 150
aldosterone role in, 39–40
diuretics and, 223, 224f
genetic mechanisms of, 25–26, 26f, 28f
renovascular hypertension and, 94
sympathetic nervous system activity impact on,
29–30, 30f, 32
Sodium channel. See Epithelial sodium channel
(ENaC).
Sodium chloride (NaCl), for acid-base changes, with
diuretics, 225
Sodium intake, dietary
aldosterone excretion rate and, 110, 112f
as risk factor, 6, 50
genetic variants of, 23, 42
CHEP 6 guidelines for, 564
effect on serum potassium, 110, 111f
elderly patients and, 375, 377t
for children and adolescents, 449–450, 449f
in African Americans, 469t, 470–471
attenuated blood pressure lowering with, 478,
478f
sensitivity to, 471–472
therapeutic modification of, 477
in DASH diet, 373–374, 374f, 377t, 474
reduced. See Sodium restriction.
resistant hypertension related to, 508, 508t
salt-sensitive hypertension pathology and, 31–32, 32f
transplant hypertension and, 364
weight loss and, 372, 373t, 376
Sodium nitroprusside
for children and adolescents, 450, 454t
for hypertensive emergencies, 519, 520t, 521–522
for preeclampsia, 436, 437t
for pregnancy-related hypertension, 434
Sodium restriction
blood pressure response to, 202–203, 203f
for children and adolescents, 558
for elderly patients, 459, 459t
for hypertension, 217
for isolated systolic hypertension, 174
for preeclampsia, 432, 435
in DASH diet, 373–374, 374f, 377t
Sodium retention
aldosterone role in, 39–40
diuretics effect on, 213, 214f, 215, 216
adaptive changes to, 223, 224f
genetic mechanisms of, 25–26, 26f, 28f
in infants, 446
in kidney disease, 351, 357
transplant hypertension and, 361, 364
Sokolow-Lyon criteria, for left ventricular hypertrophy,
179t, 341
SOLVD (Studies of Left Ventricular Dysfunction), 336,
343, 343f
diabetic patients in, 411t, 414
SOS (Swedish Obese Subjects) study, 378
Sotalol
molecular structure of, 232, 235f
pharmacokinetic properties of, 232–233, 233t
South Americans. See Hispanics.
South Asians, hypertension in, 493–496
epidemiologic studies of, 496
in India, 493–495, 494t
in other populations, 495–496
treatment implications of, 496
genetic studies in, 19t
global burden of, 493, 494t
Indian population
prevalence studies of, 493–495, 494t, 495t
risk factors for, 495
mortality rates by region, 493, 494t
prevalence trends of, 4, 4t, 468, 493
stroke risk and, 394, 395f, 396
Soy protein, blood pressure response to, 206–207
Special populations, hypertension in
adolescents as, 440–454. See also Adolescents.
children as, 440–454. See also Children.
older patients as, 457–465. See also Elderly patients.
pregnant women as, 429–438. See also Pregnancy.
racial and ethnic perspectives. See Race/ethnicity;
specific ethnicity, e.g. African Americans.
Special situations, hypertension in
crises as. See Hypertensive crises.
emergencies as, 517–523. See also Hypertensive
emergency(ies); Hypertensive urgency(ies).
perioperative period as, 512–515. See also
Perioperative hypertension.
resistance to treatment, 498–509. See also Resistant
hypertension.
Sphygmomanometer(s). See also specific type, e.g.
Mercury sphygmomanometer.
aneroid, 59
calibration of, 60–61, 60f
CHEP 6 guidelines for, 561
environmental concerns about, 58–59
historical perspective of, 49, 58
inspection for quality assurance, 66
oscillometric devices vs., 59
technical problems with, 144, 172
Spironolactone
adverse effects of, 225, 227
for aldosteronism, glucocorticoid-remediable, 116
for children and adolescents, 450, 453t
for heart failure, 343
for hypertension, 295
for isolated systolic hypertension, 174
for primary aldosteronism, 114, 114f
for renal potassium-wasting disorders, 106, 107f,
107t, 109
for resistant hypertension, 503, 505f, 506
mechanism of action, 40
pharmacokinetics of, 214t, 215
Sponsor organizations, representation in education
program, 551, 552, 553, 553t
Spontaneously hypertensive rat (SHR), sympathetic
nervous system of, 31, 32
ST-segment elevation myocardial infarction
hypertension management with, 336–337
myocyte death with, 341
Stage 1 hypertension
definition of, 6–7, 7t
evolving classifications for, 53–54, 54t
in children, 440
in elderly patients, 457
JNC 7 guidelines for, 554t, 555, 556, 557
WGTF 4 guidelines for, 559t, 560f, 561
Stage 2 hypertension
definition of, 6–7, 7t
evolving classifications for, 53–54, 54t
in children, 440
in elderly patients, 457, 463
JNC 7 guidelines for, 554t, 555, 557
WGTF 4 guidelines for, 559t, 560f, 561
Stages-of-change model, for dietary changes, 207
Staging, of hypertension
CHEP 6 guidelines for, 561, 562t–563t, 565f
definition of, 6–7, 7t
evolution of, 53–54, 54t
in children, 440
in elderly patients, 457, 463
JNC 7 guidelines for, 554t, 555, 566
Staging, of hypertension (Continued)
WGTF 4 guidelines for, 558, 559t, 560f, 561
WHO endorsements for, 53, 171, 496, 561, 566
Standard deviation of the difference (SDD), in home
blood pressure readings, 72, 76
sample size and, 81
treatment efficacy and, 79, 79f
Standard of care (SOC), in outcome studies, 309–310,
309f
STAR (STents in Atherosclerotic Renovascular disease),
103
Statins
antihypertensive drug interactions with, 420–421,
420t, 539
for dyslipidemia, 423
for metabolic syndrome, 422, 422t
for stroke prevention, 400, 400t
guidelines for, international comparisons of, 573
Statistical analyses
in meta-analyses, 318
of ambulatory blood pressure monitoring, 88–89, 89t
regulatory perspectives of, 537
Statistical estimation, of genetic effects, 15–16
Steno Diabetes Center, in Copenhagen, 422
Stenosis
of carotid arteries, in untreated hypertension, 156f,
165
of renal artery. See Renal artery, stenosis of.
transplant hypertension and, 364
Stents and stenting, renal angioplasty plus, for
renovascular hypertension, 102, 501t
clinical trials on, 102–103
STents in Atherosclerotic Renovascular disease (STAR),
103
Step-down pharmacotherapy, for children, 560–561, 560f
Stepped care program
for diuretic therapy, 217, 223
for hypertension treatment, 305, 544
in children, 560–561
Steroids
anabolic, resistant hypertension related to, 500f, 507,
508t
for infants, sodium retention with, 446
hypertension related to, 145
immunosuppressive. See Corticosteroids.
sex
adrenocortical enzyme deficiency impact on,
106–108, 108f
hypertension related to, 145
withdrawal from, transplant hypertension and, 362
Stethoscope
critical skills for use of, 60, 60f
inspection for quality assurance, 66
proper technique for using, 61–62
STICH (Surgical Treatment for Ischemic Heart Failure)
study, 346
Stiffness, of arteries. See Arterial stiffness.
STONE (Shanghai Trial of Nifedipine in the Elderly),
161f, 272t
STOP-1 (Swedish Trial in Old Patients with
Hypertension no. 1), 159f, 161, 161f, 162f, 163
STOP-2. See Swedish Trial in Old Patients with
Hypertension no. 2 (STOP-2).
STORM (Sibutramine Trial on Obesity Reduction and
Maintenance), 378
Stress
eating behavior related to, 372
home blood pressure monitoring and, 73–74, 73t, 77
in African Americans, 470
mental, increased sympathetic response to, 33
oxidative. See Oxidative stress; Reactive oxygen
species.
sleep disturbance as, 139
Stress echocardiography, for ischemic heart disease
assessment, 179t, 180
Stress management, 564, 566
Stress testing, for perioperative hypertension, 514, 515,
515f
Stretch receptors, arterial, 29, 30f, 31f
Stroke/stroke mortality, 392
acute, prevention by blood pressure lowering,
398–399
angiotensin-converting enzyme inhibitors for,
247–248, 248f
angiotensin II receptor blockers for, 259f, 263

Stroke/stroke mortality (Continued)
blood pressure lowering for, 394–399
acute stroke, 398–399
benefits of, 394–395, 395f–396f
for primary prevention, 394–397
for secondary prevention, 397–398, 398f
other interventions vs., 399–401, 400t
patient subgroup effects, 396, 396f
relative benefits of different regimens, 396–397, 396f
risk reduction related to differences in, 396f–397f,
397
blood pressure risks for, 394, 398–397
calcium channel blockers and, 271–272, 278
CHEP 6 guidelines for, 564t
data on, 156, 160
age-adjusted, 155
defining hypertension and, 50, 51, 52f
diabetes mellitus and, 406, 407, 408, 408f
diuretics effect on, 218–219, 220f–221f
global epidemiology of, 392–394, 393f
hemorrhagic, 392, 394, 398, 399, 400
hypertension risk for, 5, 7, 8f, 394, 398
antihypertensive drug therapy goals and, 51–52
diuretic therapy impact on, 29
in older individuals, 13, 13t
treatment trials for lowering, 394–399
in African Americans, 469
in East Asians, 489, 490
in elderly patients, 457, 459, 459t
in South Asians, 493, 494t
in untreated hypertension, 159–161, 160f–161f
incidence of, 392–393
age-adjusted, 393, 393f
U.S. decline in, 393, 394f
worldwide, 393–394, 393f
ischemic, 160, 392, 394, 399, 400, 401
hypertensive emergency with, 517, 518, 518t, 519
management of, 517, 518, 518t, 519
isolated systolic hypertension and, 170, 174
JNC 7 guidelines on, 555, 556t
lacunar, 392, 393f
meta-analyses of, 317, 319t
active regimens and controls, 318, 320f
angiotensin receptor blockers, 322, 322f
blood pressure and risk, 323, 323f
different active regimens, 318, 321f
neuroimaging of, 184, 392
outcome studies on, 310, 311
pathologic categories of, 392, 393f
peripheral artery disease associated with, 385, 387
predictors of, 394, 394t
preeclampsia and, 431, 432, 437
prevention of
anticoagulant therapy for, 399–400, 400t
antiplatelet therapy for, 399, 400t
blood pressure lowering for, 394–399
carotid revascularization for, 400–401, 400t
hepatic 3-hydroxy-methylglutaryl–coenzyme A
reductase inhibitors for, 400, 400t
antihypertensive drug interactions with,
420–421, 420t
in postmenopausal women, 423
statins for, 400, 400t, 423
primary, 394
prevention by blood pressure lowering, 394–397
recurrent, 394
prevention by blood pressure lowering, 397–398,
398f
risk factors for, 394, 394t
secondary, 394
prevention by blood pressure lowering, 397–398,
398f
transient ischemic attack vs.
cumulative risk, 392, 393f
symptom duration, 392, 393f
white-coat hypertension risk for, 87
Stroke syndromes, hypertensive
assessment of, 183–184
demographics of, 183
pathogenesis of, 183
Stroke volume (SV), cardiac
acromegaly impact on, 150
heart transplant and, 347
in isolated systolic hypertension, 171
left ventricular hypertrophy and, 179
Stroke volume (SV), cardiac (Continued)
sleep apnea impact on, 136–138, 137f–138f
prognostic consequences of, 139, 139f
sympathetic nervous system regulation of, 31f
Studies of Left Ventricular Dysfunction (SOLVD), 336,
343, 343f
diabetic patients in, 411t, 414
Study designs
for genetic research, 16–17
for new drug development, 540–542, 541f
outcome, issues of, 307–313. See also Outcome
study(ies).
Study of Health Assessment and Risk in Ethnic Groups
(SHARE), 496
Study on Ambulatory Monitoring of Blood Pressure and
Lisinopril Evaluation (SAMPLE), 80
Study on Cognition and Prognosis in the Elderly (SCOPE),
159f, 162f, 164, 244, 276, 280, 319t, 463, 463t
angiotensin II receptor blockers in, 258, 259, 259f,
322, 322f
diabetic patients in, 411t, 414
vascular dementia in, 401, 402f
Subacute-phase response, to diuretics, 218
Subadditivity, in multiple dietary changes, 207
Subarachnoid hemorrhage, 160
hypertensive emergency with, 517, 518, 518t
management of, 521
stroke related to, 392, 393–394, 393f
Subclinical cardiovascular disease, 195
Subjective medication intolerance, 506
Substance P
angiotensin-converting enzyme inhibitors effects on,
248, 249
angiotensin receptor blockade and, 254, 264
mediating role of, 26f, 43
Substance use, illicit
in adolescents, 446, 446t, 560
resistant hypertension related to, 500f, 507, 508t
Succinate dehydrogenase, germline mutations of,
secondary hypertension related to, 122
Sudden cardiac death, 161–162
Sulfonamides, diuretics interaction with, 227
Superiority trials, equivalence vs. noninferiority,
307–310, 308f
Superoxide anion, oxidant, angiotensin II and, 39
Supine position, for blood pressure measurement, 63
Surgery, hypertension related to, 512–515. See also
Perioperative hypertension.
in children and adolescents, 446, 446t
Surgical repair/reconstruction
of coarctation of the aorta, 148
of mitral valve, 345–346
Surgical resection
of ACTH-producing tumors, 110
of adrenal glands. See Adrenalectomy.
of pheochromocytoma, 126–129
acute hypertensive crises with, 128
anesthesia for, 128
long-term postoperative follow-up for, 128–129
preoperative management of, 126–128
of pituitary gland, indications for, 110, 149
Surgical revascularization
carotid, for stroke prevention, 400–401, 400t
coronary, assessment of, 179t, 180
renal, for renovascular hypertension, 95, 101
clinical trials on, 102
patient selection factors, 101, 101t
Surgical Treatment for Ischemic Heart Failure (STICH)
study, 346
Surgical ventricular restoration (SVR), for heart failure,
346
Surrogate endpoint, 535
Survival and Ventricular Enlargement (SAVE) trial, 336,
343
SV. See Stroke volume (SV).
SVR. See Systemic vascular resistance (SVR).
SVR (surgical ventricular restoration), for heart failure,
346
Swedish Obese Subjects (SOS) study, 378
Swedish Trial in Old Patients with Hypertension no. 1
(STOP-1), 159f, 161, 161f, 162f, 163
Swedish Trial in Old Patients with Hypertension no. 2
(STOP-2), 219, 220f–221f, 224, 319t
calcium channel blockers in, 272t, 273, 274t, 276t, 280
combined systolic-diastolic hypertension, 459, 459t
Index 611
Sympathetic agents, centrally acting, for transplant
hypertension, 365t, 366
Sympathetic nervous system (SNS)
α-adrenergic blockers effects on, 286, 290, 470
angiotensin-converting enzyme inhibitors effects on,
241–242, 241t
blood pressure regulation role, 286
candidate genes of, 19t
diuretics effect on, 217, 226
drugs affecting, hypertension related to, 145–146
efferent output of, 29, 31f
essential hypertension role of, 34, 35f
imidazoline agonists effects on, 297–298, 297f
in perioperative hypertension, 512, 513, 513t
kidney disease role, 351–352
natriuretic peptides modulation of, 41, 41f–42f
obesity and, 370–371, 371f, 378
obstructive sleep apnea syndrome and, 135, 136t,
137, 137f, 140
pathophysiologic role of, 29–33
exaggerated response triggers, 32
in African Americans, 469t, 470, 471, 472, 473f
increased activity mechanisms in, 29, 30f–31f, 32
neuronal groups in, 31–32, 32f
reflex controls in, 29–30, 30f, 31f
renal stimulation and, 32–33
renin-angiotensin-aldosterone system interactions
with, 29, 30
transplant hypertension and, 362
vascular smooth muscle cell regulation by, 286
Sympatholytic agents, centrally acting, 33
for obesity-related hypertension, 379, 380t
Sympathomimetic activity
in resistant hypertension, 509
intrinsic, β-adrenergic blockers effect on, 231, 232t,
236
Sympathomimetic agents
hypertension related to, 145–146
antidepressant agents and, 146
resistant hypertension related to, 500f, 508, 508t
Syncope, with α1-adrenoceptor antagonists, 292
Syst-China. See Systolic Hypertension in China trial
(Syst-China).
Syst-Eur. See Systolic Hypertension in Europe trial
(Syst-Eur).
Systemic arterial hypertension. See Hypertension.
Systemic arterial system
in isolated systolic hypertension, 173
tubular models of, 36, 36f
Systemic vascular resistance (SVR). See also Peripheral
vascular resistance.
calcineurin inhibitors impact on, 361, 362
elevated
pathophysiology of, 33, 34f
reversal of, 33
sympathetic nervous system regulation of, 31f
Systolic blood pressure (SBP)
age factor of, 5, 169, 170f
coronary heart disease relationship to, 171, 171f,
328, 330f
heart failure and, 340–341
aortic stenosis and, 234
as drug research endpoint, 535, 543, 546
as primary staging target, 6–7, 7t
body mass index impact on, 6
central, in left ventricular hypertrophy, 179
CHEP 6 guidelines for, 561, 562t–563t
diet and
factors that reduce, 201–205, 202f–205f
factors with limited effects, 205–207
importance to hypertension sequelae, 8–10, 9f, 9t,
10t
in chronic kidney disease, treatment goals for,
352–354, 353f–354f
in hypertension definition, 3
classifications of, 53–54, 53f, 54t
in perioperative hypertension, 514–515, 515f
in peripheral artery disease, 386–387
age- and sex-adjusted percentages by disease
status, 386, 386t
age-adjusted mean levels by disease status, 386,
386t
odds ratios of isolated lesions, 387, 387t
in pulse pressure, 5, 11–12
mean levels of, global trends of, 5
612 Index
Systolic blood pressure (SBP) (Continued)
measurement of. See Blood pressure
measurement/monitoring.
stroke risk related to
primary, 394, 394f, 396, 396f, 397f
secondary, 397–398, 398f
weight loss effect on, 372–378, 373t, 374f–376f, 377t
Systolic function/dysfunction, in heart failure, 179t, 181
aging impact on, 340–341
treatment of, 342–348
Systolic hypertension, 3
angiotensin-converting enzyme inhibitors for, 243
classifications of, 53–54, 53f, 54t
in children, 440
WGTF 4 guidelines for, 554t, 558, 559t
in elderly patients
diastolic hypertension with, 459–460, 459t
resistant, 499t, 507
isolated, 169–175. See also Isolated systolic
hypertension (ISH).
resistant, 498
in older patients, 499t, 507
measurement issues, 499
treatment guidelines for
for children, 554t, 558, 559t
international comparisons of, 572–574, 572f, 572t,
573t, 575t
JNC 7, 554t
Systolic Hypertension in China trial (Syst-China), 173,
272t, 276t
isolated systolic hypertension results of, 460, 460t,
461–462
treatment considerations based on, 489, 490
untreated hypertension and, 159f, 161f, 162f, 163
Systolic Hypertension in Europe trial (Syst-Eur), 173,
272t, 276t, 277, 280, 319t, 489
diabetic patients in, 407, 408
isolated systolic hypertension results of, 460, 460t,
461–462, 462t, 463, 463t
untreated hypertension and, 159f, 161f, 162f, 163,
164
vascular dementia in, 402, 402f
Systolic Hypertension in the Elderly Program (SHEP)
trial, 35, 159f, 173, 280, 341
cognitive impairment assessment, 463, 463t
East Asians in, 489
isolated systolic hypertension results of, 460, 460t,
461–462, 462t
on diuretics, 219, 222f, 223, 224
resistant hypertension in, 499
untreated hypertension and, 161f, 162f, 163
vascular dementia in, 401, 402f
T-tube, for ambulatory monitoring device calibration, 90
Tachycardia
exercise-induced, 540
heart transplant and, 347
ventricular, diuretic-induced, 224
Tacrolimus
hypertension related to, 146
transplant hypertension and, 361
regimen modifications, 366–367
Tactile skills, for blood pressure measurement, 60, 60f, 62
Tadalafil, 292
TAIM (Trial of Antihypertensive Interventions and
Management), 375
Takayasu’s arteritis, 148
renovascular hypertension with, 94
Talking, home blood pressure monitoring and, 73, 73t
Tamsulosin, 288, 289f
Target goals
for blood pressure, 7, 53, 173–174
for isolated systolic hypertension, 174–175
Target organ damage (TOD)
assessment of, 178–187
for arteriopathy, 181–183
for cerebrovascular disease, 183–184
for chronic kidney disease, 185–187, 186t
for heart disease, 178–181, 179t
for retinopathy, 184–185, 185t
general approach to, 178
importance of, 178
CHEP 6 guidelines for, 561, 562t–564t
Target organ damage (TOD) (Continued)
degree factors, 178
diabetes mellitus and, 406, 407, 408f, 413
disease management follow-up on, 532
genetics of, 27
home blood pressure and, 76–77, 80
in African Americans, 468, 469, 474
in children and adolescents, 447, 448, 449f, 450
in elderly patients, 458
in pregnancy-related hypertension, 431, 432
in redefining hypertension, 54, 55
in resistant hypertension, 498, 509
JNC 7 guidelines for, 555
natural history of, 155, 156f, 157
progressive, in hypertensive emergencies, 517, 518
management of, 519–522
risk groups for, cross-classification of, 12, 12f
subclinical, in untreated hypertension, 164–165
sympathetic nervous system activity and, 30–31
treatment implications of, 178
international comparisons of, 573, 574
vascular tone and, 33
WGTF 4 guidelines for, 560
white-coat hypertension and, 53
Task Force on Blood Pressure Control in Children, 552,
560f
Technetium-99 diethylenetriamine penta-acetic acid
scan, for renovascular hypertension, 98–99
Tecumseh study, of home blood pressure monitoring,
74, 77
Telephone care, in disease management programs, 528,
532
Telmisartan
ambulatory blood pressure monitoring for, 89
for diabetes-related hypertension, 414
for Hispanic populations, 485
for transplant hypertension, 365t, 366
pharmacologic properties of, 255t, 256
Telmisartan Randomized Assessment Study in ACE
Intolerant Subjects with Cardiovascular Disease
(TRANSCEND), 263–264, 414
Tenormin after Stroke and TIA (TEST), 159, 159f, 162f
Teratogens, 432, 433t
β-adrenergic blockers as, 432–433
angiotensin-converting enzyme inhibitors as,
248–249, 431, 433t, 434–435
angiotensin II receptor blockers as, 431
calcium channel blockers as, 281
spironolactone as, 434
vasodilators as, 434
Terazosin, 288
for children and adolescents, 450, 453t
for diabetes-related hypertension, 413
for transplant hypertension, 365t, 366
pharmacology of, 288, 289f
Terfenadine, 539
Terminal digit bias, in blood pressure measurement,
64, 65f
Tertatolol, 298
TEST (Tenormin after Stroke and TIA), 159, 159f, 162f
Tetany, diuretic-induced, 225
Tezosentan, 297
TGFB1 (transforming growth factor-β1), candidate
genes of, 19t
Th/R (ventricular wall thickness to chamber radius),
179, 179t, 180
Thiazide diuretics, 215
acid-base changes associated with, 225
adverse effects of, 223, 224, 224f, 226, 227
cardiac arrest associated with, 224, 225f
for children and adolescents, 450, 452t–453t
for diabetes-related hypertension, 410f, 411t, 412
for heart failure, 343
for hypertension
angiotensin-converting enzyme inhibitors with, 242
class effect of, 218
in elderly patients, 219, 459, 460, 461, 461t, 464
response phases to, 217–218, 223
for resistant hypertension, 498, 504, 505, 505f
for ST-segment elevation myocardial infarction, 337
for transplant hypertension, 365, 365t, 366
guidelines for
CHEP 6, 562t, 564t, 565, 565f
international comparisons of, 573–574
JNC 7, 557, 557f
Thiazide diuretics (Continued)
hyperparathyroidism cautions with, 150
lipid-lowering drug interactions with, 420, 420t, 421,
424
nephron sites of action, 213, 214f
pharmacogenetic studies of, 21, 25
pharmacokinetics of, 213, 214t
regulatory development of, 542, 545
Third Adult Treatment Panel of the National
Cholesterol Education Program, 158
Thrombocytopenia, in preeclampsia, 429, 435
Thrombosis
of large arteries, 183, 184
of renal artery, in infants, 446
Thyroid disorders
hypertension related to, 149–150
resistant hypertension related to, 501t, 503
Thyroid replacement therapy, 149
TIA. See Transient ischemic attack (TIA).
TIBET (Total Ischaemic Burden European Trial), 335
Tibial artery, peripheral artery disease in, 385
Tibioperoneal lesions, in peripheral arterial disease, 387,
387t
Time course of treatment, home blood pressure
monitoring for, 80
Time of day
blood pressure monitoring and
ambulatory, 85–86, 86f
in home, 72, 73, 73t, 77
obstructive sleep apnea syndrome and, 135, 136, 137,
138f
Timolol
elimination characteristics of, 234t
molecular structure of, 232, 235f
pharmacodynamic properties of, 231–232, 232t
pharmacokinetic properties of, 232–233, 233t
Tissue binding
by angiotensin-converting enzyme inhibitors, 240–241
by angiotensin II receptor blockers, 256
competitive, 256
surmountable, 256
TOD. See Target organ damage (TOD).
TOHP (Trials of Hypertension Prevention), 202f
obesity in, 375–376, 377t
TOMHS. See Treatment of Mild Hypertension Study
(TOMHS).
TONE (Trial of Nonpharmacologic Interventions in the
Elderly), 375, 377t, 459
Torsemide
for resistant hypertension, 504
for transplant hypertension, 365t, 366
pharmacokinetics of, 214–215, 214t
Total Ischaemic Burden European Trial (TIBET), 335
Total peripheral resistance (TPR), diuretics effect on,
217f, 218
Toxic substances, environmental concerns about, 58–59
Toxicity(ies), drug, diuretic-induced, 227
Toxicology studies, regulatory perspectives of, 537
TPR (total peripheral resistance), diuretics effect on,
217f, 218
TRACE (Trandolapril Cardiac Evaluation) study, 336,
343
Training programs, for blood pressure measurement
historical perspective of, 58
knowledge assessment in, 66
recommendations for, 59–60, 59f
standardized monitoring of, 64–66, 65f
Trandolapril, 240t, 243
clinical trials on, 244, 245, 246, 247
for chronic kidney disease, 356
for diabetes-related hypertension, 411t
for ST-segment elevation myocardial infarction, 337
home monitoring evaluation of, 78
pharmacology of, 239
Trandolapril Cardiac Evaluation (TRACE) study, 336, 343
TRANSCEND (Telmisartan Randomized Assessment
Study in ACE Intolerant Subjects with
Cardiovascular Disease), 263–264, 414
Transcendental meditation, as treatment, 489
Transesophageal echocardiography, for stroke
assessment, 184
Transforming growth factor-β, in African Americans,
469t, 471
Transforming growth factor-β1 (TGFB1), candidate
genes of, 19t

Transient ischemic attack (TIA), 392
CHEP 6 guidelines for, 564t
hypertension risk for, 7
secondary prevention trials on, 398, 398f
stroke vs.
cumulative risk, 392, 393f
symptom duration, 392, 393f
Transplant hypertension, 361–367. See also specific
organ, e.g., Bone marrow transplantation.
calcineurin inhibitors and, 361–363, 364–366
causes of, 363, 363t
circadian BP rhythm with, 362–363, 363f
clinical features of, 362–363, 363f
clinical implications of, 361, 367
complications of, 361–362
corticosteroids and, 362
evaluation of, 363–364
graft survival and, 361
heart transplant and, 346–348, 347t
in children and adolescents, 558
incidence of, 361
outcome-related, 361
allograft rejection and, 363–364
pathogenesis of, 361–362
population mediators of, 363–364
stenosis risk factors with, 364
treatment of, 364–367
immunosuppressive regimen modifications,
366–367
native nephrectomy, 367
nonpharmacologic therapies, 364
pharmacologic therapies, 364–366, 365t
Transsphenoidal microsurgery, for pituitary tumors, 149
Transtheoretical model, for dietary changes, 207
Transthoracic echocardiography, for stroke assessment,
184
Tranylcypromine, hypertension related to, 146
Treatment, of hypertension
“Consumer Reports” analysis of, 311
decisions about, patient participation in, 532
diet as, 201–209. See also Diet.
disease management practitioners role, 527–533. See
also Disease management services.
future perspectives of, 527–548
antihypertensive drug regulations, 535–546
hypertension disease management services, 527–533
guidelines for. See Clinical practice guidelines
(CPGs).
lifestyle changes as. See Lifestyle modifications.
medications as. See Pharmacotherapy.
stepped care program for, 305, 544
diuretics and, 217, 223
in children, 560–561
Treatment in Obese Patients with Hypertension Study,
378, 379
Treatment of Mild Hypertension Study (TOMHS), 227,
269
α-adrenergic blockers in, 290, 291
African Americans in, 477
lessons learned from, 306
obesity in, 375
South Asians in, 496
Triage, for hypertensive emergencies, 518, 519f
Trial of Antihypertensive Interventions and
Management (TAIM), 375
Trial of Nonpharmacologic Interventions in the Elderly
(TONE), 375, 377t, 459
Trial of Preventing Hypertension (TROPHY), 264
Trials of Hypertension Prevention (TOHP), 202f
obesity in, 375–376, 377t
Triamterene
adverse effects of, 225, 227
for children and adolescents, 450, 453t
pharmacokinetics of, 214t, 216
Trichlormethiazide, 272t
Tricyclic antidepressants, hypertension related to, 146
Triglycerides, elevated plasma
α-adrenergic blockers effects on, 291
β-adrenergic blockers effect on, 236, 421
historical studies on, 306, 327
metabolic syndrome therapy and, 422
treatment principles for, 422
vascular wall impact of, 419
Triple-drug therapy, antiviral, hypertension related to,
148
TROPHY (Trial of Preventing Hypertension), 264
Trough ratio, peak and, blood pressure monitoring for
ambulatory, 89
in home, 72, 80
Trp460 allele, 27–28
Tubuloglomerular feedback, 473
Tumor(s)
ACTH producing, 109–110
aldosterone-producing, 110
hyperplasia vs., 112–113, 148, 149
hypertension related to. See Primary
aldosteronism.
malignant transformation of, 115
catecholamine-secreting, 119. See also
Pheochromocytoma.
deoxycorticosterone producing, 106
malignant, post-heart transplant, 348
of central nervous system, resistant hypertension
related to, 500f, 504
pituitary, surgical resection of, 110, 149
Turner’s syndrome, hypertension related to, 446t, 448
24-Hour urine studies
for pheochromocytoma, 119, 121f, 122, 123, 124f
episodic, 123
for pregnancy-related hypertension, 430
for primary aldosteronism, 110, 113
for renal potassium-wasting disorders, 106, 107f, 109
for renovascular hypertension, 98
24-Hour blood pressure monitoring, 85–91. See also
Ambulatory blood pressure monitoring
(ABPM).
Twins, genetic studies on, 15, 25
Type 1 diabetes mellitus, hypertension in
angiotensin-converting enzyme inhibitors effect on,
244–245
β-blocker cautions with, 236
nephropathy with, 409
prevalence of, 406
Type 1 error, in outcome studies, 311, 311f
Type 2 diabetes mellitus, hypertension in
angiotensin II receptor blockers effect on, 257–258, 406
angiotensin receptor blockers and, 257–260, 356–359
antihypertensive agents impact on, 414
β-blocker cautions with, 236, 406
cardiovascular disease and, 407, 408f
in children and adolescents, 447, 450
nephropathy with, 409
Type 2 error, in outcome studies, 311
Tyramine, foods containing, hypertension related to,
146
Tyrosine kinases
fms-like, in preeclampsia, 430t, 435
in angiotensin II–converting enzyme mediation, 38,
38f
UK 69 578, for hypertension, 298
UKPDS. See United Kingdom Prospective Diabetes
Study (UKPDS).
Ultrasound, Doppler, for renovascular hypertension,
95, 96
performance characteristics of, 97t, 99
resistant, 501t, 502
Undertreatment. See Untreated hypertension.
United Kingdom Prospective Diabetes Study (UKPDS),
54, 55, 319t
cardiovascular disease in, 407, 408f
chronic kidney disease in, 353, 354f, 358
diabetic patients in, 412–413
on diuretics, 220f–221
strokes and stroke mortality in, 408
United Kingdom’s BRItish Genetics of HyperTension
(UK BRIGHT) study, 18
United Network of Organ Sharing (UNOS), 346–347
United States
Cardiovascular Health Study of, 8–9, 9t
clinical practice guidelines of. See United States
guidelines.
life expectancy in, 173
mortality trends in, 156–157, 160
occupational health regulations in, 58
prevalence trends in, 3–4, 4f, 4t
in older individuals, 12–13, 13t
renal failure trends in, 163–164
Index 613
United States guidelines, 551–561
Canadian guidelines vs., 553, 553t
for adults, 561–565, 562t–564t, 565f
European guidelines vs., 571–575
differences, 572–575, 573t
major agreements, 571, 572f, 572t
on first-choice drugs, 573–574, 574f–575f
on prehypertension, 572
on total cardiovascular risk, 573
on treatment indications, 574
other issues in, 574–575
for children and adolescents, 558–561, 559t, 560f
historical perspective of, 551–552
of Joint National Committee
British guidelines vs., 575, 575t
for adults, 553–557, 554t, 556t, 557f
University(ies), representation in education program,
552, 553t
University-based clinics
pharmacist use in, 530
resistant hypertension associated with, 504, 504t,
506
UNOS (United Network of Organ Sharing), 346–347
Untreated hypertension, 155–166
adverse events with, 157–164, 517
aortic dissection as, 164
cardiovascular death as, 161–162, 162f
heart failure and, 162–163
ischemic heart disease and, 157–159, 158f–159f
peripheral vascular disease and, 164
renal failure and, 163–164, 163f
stroke and, 159–161, 160f–161f
vascular dementia and, 164
elastic arterial stiffness with, 36–37, 166
emergencies related to, 517–523. See also
Hypertensive emergency(ies).
incidence of, 517
natural history of, 155–157, 166
schematic model of, 155, 156f
prehypertension and, 156f, 165–166
subclinical target organ damage with, 164–165
urgencies related to, 517–518
management of, 522
Upper extremity. See Arm entries.
Urapidil, 298
Urbanization, in India, impact on population, 493–495,
494t, 495t
Uric acid
angiotensin II receptor blockers effect on, 256
as pathophysiologic factor, 35–36
in essential hypertension, 34, 35f
diuretics effect on, 224f, 226
in preeclampsia, 431, 436
transplant hypertension and, 365
Urinalysis, for chronic kidney disease assessment, 186
Urinary tract, lower, α1-adrenoceptor antagonists and,
286, 288, 291
Urine studies
for hypercortisolism, 149
24-hour
for pheochromocytoma, 119, 121f, 122, 124f
episodic, 123
for pregnancy-related hypertension, 430
for primary aldosteronism, 110, 113
for renal potassium-wasting disorders, 106, 107f,
109
for renovascular hypertension, 98
Urodilatin, mediating role of, 41f, 42
Uroselective α1-adrenoceptors, 286, 288, 291, 292
U.S. Department of Commerce, Bureau of Standards,
551
U.S. Department of Health and Human Services, federal
agencies of, representation in education
program, 552, 552t–553t
U.S. Preventive Services Task Force (USPSTF), 552
Uvulopalatoplasty, for obstructive sleep apnea
syndrome, 140
V-hypertensives, 518
VA-HIT (Veterans Affairs High-Density Lipoprotein
Cholesterol Intervention Trial), 423
VA trials. See Veterans Affairs (VA) trials.
VAD (ventricular assist device), for heart failure, 346
614 Index
Vagal input/tone
heart transplant and, 347
sympathetic nervous system activity impact on, 29, 30f
Val-HeFT (Valsartan Heart Failure Trial), 258, 259f,
261–262, 344
VALIANT (Valsartan in Acute Myocardial Infarction),
258, 259f, 262
Validation criteria, for blood pressure devices
ambulatory, 90–91
electronic, 61
Validity, of home monitoring, for antihypertensive
treatment, 78–79, 78f–79f
Valsartan
for diabetes-related hypertension, 411t
pharmacologic properties of, 255t, 256
Valsartan Antihypertensive Long-Term Use Evaluation
(VALUE), 244, 258, 259–260, 259f
calcium channel blockers and, 271, 272t, 273, 274t,
276t, 277, 281
diabetic patients in, 411t, 414
stroke in, 397
Valsartan Heart Failure Trial (Val-HeFT), 258, 259f,
261–262, 344
Valsartan in Acute Myocardial Infarction (VALIANT),
258, 259f, 262
VALUE. See Valsartan Antihypertensive Long-Term Use
Evaluation (VALUE).
Valvular heart disease (VHD), hypertension risk for, 9f
VAMCs (Veterans Affairs Medical Centers)
major overhaul of, 527
use of pharmacists in, 529, 530
Vardenafil, 292
Variability
in home blood pressure monitoring
demographic influences on, 72
environmental influences on, 72–73, 73t
standard limits of, 76, 76t
interindividual, in blood pressure measurement, 59,
59f
Vascular cell adhesion molecule-1 (VCAM-1), oxidative
stress and, 39
Vascular cognitive impairment (VCI), 184
Vascular dementia, 401–402
blood pressure and
as risk factor, 164, 401
treatment trials for lowering, 401–402, 402f
in elderly patients, 463
neuroimaging of, 401
prevalence of, 401
prevention of, 401–402
Vascular Dementia Project, 463–464
Vascular disorders. See Vasculopathy.
Vascular endothelial growth factor (VEGF), in
preeclampsia, 430f, 435
Vascular remodeling
angiotensin-converting enzyme inhibitors and, 242
arterial, for isolated systolic hypertension, 174
chronic sympathetic stimulation and, 29, 32
left ventricular hypertrophy and, 180
pathophysiology of, 33–34, 34f, 38f
renin-angiotensin-aldosterone system and, 38–39, 38f
Vascular smooth muscle cells (VSMCs)
contractile abnormalities of, 33, 34f, 39
endothelial dysfunction and, 40
endothelin impact on, 41
in arterial assessment, 182
in diabetes mellitus, proliferation of, 408–409, 409f
neurohormonal regulation of, 286
sympathetic nervous system activity impact on, 29,
30f, 286, 287f
vasodilators impact on, 41–43
Vascular tone
calcineurin inhibitors impact on, 361, 362
in African Americans, 469t, 472
regulation of, 33–34, 34f
Vasculoocclusive disease, peripheral artery disease
associated with, 385
Vasculopathy
cardiac allograft, 348
diabetes mellitus and, 408–409, 409f, 413
in African Americans, 469t, 472
in children and adolescents, 446, 446t
resistant hypertension related to, 501t, 504, 509
retinal vs. choroidal, in hypertensive retinopathy,
184–185, 185t
Vasoactive peptides
angiotensin-converting enzyme inhibitors effects on,
241, 249
intestinal
pheochromocytoma-related secretion of, 119
secondary hypertension and, 119
mediating role of, 41, 42–43
Vasoconstriction (VC)
essential hypertension related to, 34, 35f
imidazoline agonists effects on, 297–298, 297f
in chronic kidney disease, 351–352, 357
obesity and, 371, 371f
pathophysiologic role of, 29–30, 30f
renal, calcineurin inhibitors causing, 361
stress-induced, 33
Vasoconstrictors
β-blocker combinations with, 236
use with anesthetics, hypertension related to, 145
Vasodepressor response, to angiotensin-converting
enzyme inhibitors, 241, 242
Vasodilators, 41–43
α-adrenergic blockers vs., 291
adrenomedullin as, 43
angiotensin-converting enzyme inhibitors with, 243
calcitonin gene–related peptide as, 43
calcium channel blockers vs., 270
for arterial stiffness, 36–37
for heart failure, 343
for hypertension
in children and adolescents, 450, 453t
isolated systolic, 174
pregnancy-related, 433t, 434
for primary aldosteronism, 114, 115
for resistant hypertension, 505f, 506
for transplant hypertension, 365t, 366
intravenous, for hypertensive emergencies, 519,
520t–521t
kallikrein-kinin system as, 42–43
natriuretic peptides as, 41–42, 41f–42f
substance P as, 43
Vasomotor control center, sympathetic activity of, 29,
30–31, 31f
Vasopeptidase inhibitors, for hypertension, 298, 299f
VC. See Vasoconstriction (VC).
VCAM-1 (vascular cell adhesion molecule-1), oxidative
stress and, 39
VCI (vascular cognitive impairment), 184
VDD (ventricular/dual/dual) dual-chamber pacing, for
dilated cardiomyopathy, 345
Vegetables, for weight loss, 372, 373t, 377t
Vegetarian diet, blood pressure response to, 6, 204–205
VEGF (vascular endothelial growth factor), in
preeclampsia, 430f, 435
Venlafaxine, hypertension related to, 146
Venoms, scorpion and spider, hypertension related to,
148
Venous sampling, bilateral, for adrenal adenoma
localization, 113, 114f
Ventricle(s), cardiac. See Left ventricle; Right ventricle.
Ventricular assist device (VAD), for heart failure, 346
Ventricular ectopy, diuretic-induced, 224
Ventricular tachycardia, diuretic-induced, 224
Ventricular wall thickness to chamber radius (Th/R),
179, 179t, 180
Verapamil
α-blocker combinations with, 292
angiotensin-converting enzyme inhibitors with,
243
β-blocker combinations with, 236
clinical outcome studies on, 272t, 276t, 309, 309f,
310, 353t
delivery systems for, 90
for diabetes-related hypertension, 411t
for hypertension, 268, 269, 270t
for resistant hypertension, 505f, 506
for transplant hypertension, 365t, 366
Verapamil in Hypertension and Atherosclerosis Study
(VHAS), 221f, 272t, 273, 274t, 276t, 278, 278t,
319t
Veterans’ Administration Cooperative Study on
Antihypertensive Agents, 51, 222, 517
α-adrenergic blockers in, 291
stroke in, 394–395
Veterans Affairs High-Density Lipoprotein Cholesterol
Intervention Trial (VA-HIT), 423
Veterans Affairs Medical Centers (VAMCs)
major overhaul of, 527
use of pharmacists in, 529, 530
Veterans Affairs Monotherapy Study, 269–270
Veterans Affairs (VA) trials
calcium channel blocker results, 269–270
lessons learned from, 305
on cardiovascular death, 161–162
on heart disease, 158–159
on heart failure, 163, 343
on renal failure, 164
on stroke, 160–161
physician inertia in, 506, 509
VHAS (Verapamil in Hypertension and Atherosclerosis
Study), 221f, 272t, 273, 274t, 276t, 278, 278t,
319t
VHD (valvular heart disease), hypertension risk for, 9f
VHL (von Hippel-Lindau disease), secondary
hypertension related to, 119, 121–122, 121t
VHL tumor suppressor gene, 27t
secondary hypertension related to, 121–122, 121t
Video testing, of blood pressure observer, 64–66
standardized monitoring of, 64, 65f
Video-tutored program, for blood pressure
measurement training, 58, 60
Vincristine, for metastatic pheochromocytoma, 130
Virilization, with adrenocortical enzyme deficiency, 107,
108
Virtual hypertension clinic, 81, 81f
teletransmission of readings, 82
Visceral obesity, 370
Visual skills
for blood pressure measurement, 60, 60f
loss of
in stroke syndromes, 183
with hypertensive retinopathy, 184–185
Vitamin C, dietary, blood pressure response to, 207
Voltage-gated calcium channel, 268
α1-adrenoceptor activation and, 287, 287f
α1-subunits of, 268, 269f
L-type subunits of, 268, 269f
Volume depletion
diuretics and
adaptive response, 216
loop, 213–214
neurohormonal response, 217, 223, 224f
for primary aldosteronism, 114, 114f
in hypertensive emergencies, 518, 519
Volume overload
in heart failure, 181
in resistant hypertension, 504
thiazide diuretics and, 215
transplant hypertension and, 361, 364
Volume regulation, for resistant hypertension, 500
von Hippel-Lindau disease (VHL), secondary
hypertension related to, 119, 121–122, 121t
VSMCs. See Vascular smooth muscle cells (VSMCs).
Waist circumference
CHEP 6 guidelines for, 564
in central obesity, 370
in Korean populations, 488
in metabolic syndrome, therapy indications based
on, 422, 422t
Waist-to-hip ratio, in central obesity, 370
Warfarin, for stroke prevention, 400, 400t
Water balance/imbalance
acromegaly and, 150
aldosterone role in, 39–40, 114
diuretic therapy impact on, 213, 214f
extracellular, reduction with diuretics, 216, 217,
218
adaptive changes to, 223, 224f
genetic mechanisms of, 25, 28f
sympathetic nervous system activity impact on,
29–30, 30f, 32
Water retention
in kidney disease, 351, 357
obesity and, 370, 371f
Wave reflection
in arterial assessment, 182
in isolated systolic hypertension, 36, 172, 173, 174
WCE. See White-coat effect (WCE).

Web sites
for antihypertensive drug regulations, 536, 536t
for clinical practice guidelines, 552
of blood pressure measurement devices, 61, 70, 91
Weight
as risk factor, 5–6
at birth
blood pressure relationship to, 440, 447
low, in African Americans, 472
in children and adolescents, blood pressure
correlation to, 447
Weight gain
adult, prevention of, 421, 424
as risk factor, 6, 49
Weight loss
as risk factor, 6
behavioral interventions for, 202, 207
blood pressure response to, 201–202, 372–378
antihypertensive medications’ effects, 375, 376,
380t
diet effects, 372–376, 374f–376f, 377t
exercise effects, 374, 376, 377t
obesity surgery effects, 378
overview of, 372, 373t, 377t
weight loss medications effects, 376–378
excessive, pregnancy-related hypertension and, 432
for African Americans, 477
for children and adolescents, 449–450, 449f
WGTF 4 guidelines for, 458, 559t, 561
for chronic disease management, 530, 532
for diabetes-related hypertension, 409–410
for elderly patients, 459, 459t
for peripheral artery disease, 388
for transplant hypertension, 364
resistant hypertension related to, 500f, 507, 508t
target setting for, 372
Weight loss diet, for weight loss, 372, 373t
Weight loss medications, blood pressure response to,
376–378
Western Electric Study, 206
WGTF. See Working Group on High Blood Pressure in
Children and Adolescents (WGTF).
WHI (Women’s Health Initiative), hypertension results
of, 464–465, 465t
White Americans, of European descent
genetic studies on, 19t, 21, 21f, 22, 482
hypertension definition for, 49–50, 50f
hypertension detection disparities in, 468, 483–484,
483t
prevalence trends of, 4, 4t, 482
White-coat effect (WCE)
age influence on, 72
diagnostic impact on, 172
home blood pressure monitoring and
clinic monitoring vs., 75, 75f
elimination of, 69, 70t, 77, 80
new drug development and, 543
nurse reduction of, 531
White-coat hypertension, 53
algorithm for evaluation of, 78, 78f
blood pressure monitoring and
ambulatory, 86–87
in home, 69, 70t, 75, 75f, 77, 80
cardiovascular event risks with, 87, 172
definition of, 75, 87
guidelines for, international comparisons of, 571
in children, 76, 560
in perioperative period, 515
pregnancy and, 430
resistant hypertension vs., 499
White-coat normotension, clinical significance of, 87
WHO. See World Health Organization (WHO).
William’s syndrome, hypertension related to, 446t, 448
Windkessel model, of arterial system, 182
Wisconsin Sleep Cohort Study, 136
Withdrawal study, randomized, of new drugs, 541f, 542
Index 615
Women’s Health Initiative (WHI), hypertension results
of, 464–465, 465t
Work hours, pregnancy-related hypertension and, 432
Working Group on High Blood Pressure in Children
and Adolescents (WGTF), 552, 553t
clinical practice guidelines of, 558–561, 559t, 560f
JNC 7 guidelines vs., 553–557, 554t, 556t, 557f
Workplace, mercury in, environmental concerns about,
58–59
World Health Organization (WHO)
blood pressure goal recommendations, 173–174
classification endorsements of, 53, 171, 496, 561, 566
clinical trials data summary of, 52
diagnostic guidelines of, 493, 494, 495
guidelines of, European and American guidelines vs.,
571–574
mortality projections of, 155
obesity definition of, 194
on observational studies, 271
stroke definition of, 392
Wrist monitors, for home blood pressure monitoring,
70
Y-tube, for manometer calibration
in home, 70, 71
in office, 60f, 61, 66
Yohimbine hydrochloride
hypertension related to, 145
resistant hypertension related to, 508, 508t
Z 13752A, for hypertension, 298
Z syndrome, 138
Zc (characteristic aortic impedance), 182