Hypertension. A Companion to Braunwald's Heart Disease

608 Pages·2007·9.939 MB·English

by  Henry R. Black, MD, and William J. Elliott, MD, PhD (Eds.)

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HYPERTENSION:A COMPANION TO BRAUNWALD’S ISBN-13:978-1-4160-3053-9
HEART DISEASE ISBN-10:1-4160-3053-0
Copyright © 2007 by Saunders,an imprint ofElsevier Inc.
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Notice
Knowledge and best practice in this field are constantly changing.As new research and experience
broaden our knowledge,changes in practice,treatment,and drug therapy may become necessary or
appropriate.Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer ofeach product to be administered to verify the recommended dose
or formula,the method and duration ofadministration,and contraindications.It is the responsibility of
practitioners,relying on their own experience and knowledge ofthe patient,to make diagnoses,to
determine dosages and the best treatment for each individual patient,and to take all appropriate safety
precautions.To the fullest extent ofthe law,neither the Publisher nor the Editors assume any liability for
any injury and/or damage to persons or property arising out ofor related to any use ofthe material
contained in this book.
Library ofCongress Cataloging-in-Publication Data
Black,Henry R.(Henry Richard)
Hypertension :a companion to Braunwald’s heart disease / Henry R.Black,
William J.Elliott.— 1st ed.
p.;cm.
Companion v.to:Braunwald’s heart disease / [edited by] Douglas P.Zipes ..[et al.].7th ed.c2005.
Includes index.
ISBN 1-4160-3053-0
1.Hypertension.2.Heart—Diseases.I.Elliott,William J.,M.D.II.Braunwald’s heart disease.III.Title.
[DNLM:1.Hypertension.WG 340 B627c 2007]
RC685.H8B553 2007
616.1’2—dc22 2006045231
Executive Publisher:Natasha Andjelkovic
Developmental Editor:Jerisha Parker
Publishing Services Manager:Frank Polizzano
Project Manager:Lee Ann Draud
Design Direction:Steve Stave
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Henry R.Black
To my wife,Benita,the love of my life and my perfect partner,and to Dana,Matt,and Sabrina,
who make it all worthwhile.To our colleagues whose work is discussed in this volume and whose
contributions to understanding and treating hypertension have saved millions of lives.
William J.Elliott
To my teachers (including my parents and spouse,Melicien Tettambel,DO),my family members,and
my students,although it is still unclear from whom I learned (and continue to learn) more.
vii
Contributors
Matthew A.Allison,MD,MPH Henry R.Black,MD
Assistant Professor ofFamily and Preventive Medicine, Charles J.and Margaret Roberts Professor ofPreventive
University ofCalifornia,San Diego,School ofMedicine, Medicine and Professor ofInternal Medicine,Rush Medical
La Jolla,California College ofRush University at Rush University Medical
Peripheral Arterial Disease in Hypertension Center,Chicago,Illinois
Angiotensin Receptor Blockers
Craig Anderson,MBBS,PhD,FRACP
Professor ofStroke Medicine and Clinical Neuroscience, Michael J.Bloch,MD
University ofSydney Faculty ofMedicine and the Institute of Associate Professor ofMedicine,University ofNevada School
Neurosciences ofRoyal Prince Alfred Hospital;Director, ofMedicine;Medical Director,St.Mary’s Risk Reduction
Neurological and Mental Health Division,The George Institute Center,Reno,Nevada
for International Health,Sydney,Australia Hypertension in the Elderly
Cerebrovascular Disease in Hypertension
Emmanuel L.Bravo,MD
Lawrence J.Appel,MD,MPH Consultant,Cleveland Clinic,Cleveland,Ohio
Professor ofMedicine,Johns Hopkins University School of Secondary Hypertension: Mineralocorticoid Excess States
Medicine,Baltimore,Maryland
Diet and Blood Pressure Robert D.Brook,MD
Assistant Professor,Department ofInternal Medicine,
Phyllis August,MD,MPH University ofMichigan Medical School,Ann Arbor,
Professor ofMedicine,Medicine in Obstetrics and Gynecology, Michigan
and Public Health,and Program Director,Nephrology and Hypertension and the Perioperative Period
Hypertension,Weill Medical College ofCornell University;
New York–Presbyterian Hospital,New York,New York David A.Calhoun,MD
Hypertension in Pregnancy Associate Professor ofMedicine,University ofAlabama
Birmingham School ofMedicine,Birmingham,
George L.Bakris,MD Alabama
Professor ofInternal Medicine and Director ofthe Pathophysiology ofHypertension
Hypertension Clinic in the Diabetes Institute,Pritzker
School ofMedicine,University ofChicago,Chicago,Illinois Barry L.Carter,PharmD
Kidney Disease in Hypertension Professor,College ofPharmacy and Department ofFamily
Medicine,University ofIowa Roy J.and Lucille A.Carver
Robert L.Bard,MA College ofMedicine,Iowa City,Iowa
Research Associate,Endothelial Function Laboratory, Hypertension Disease Management Services
University ofMichigan Medical Center,Ann Arbor,Michigan
Hypertension and the Perioperative Period John Chalmers,MD,PhD,FRACP
Emeritus Professor ofMedicine,University ofSydney Faculty
Jan N.Basile,MD ofMedicine and Flinders University School ofMedicine;
Professor ofMedicine,Medical University ofSouth Carolina; Honorary Consultant Physician,Royal Prince Alfred Hospital
Lead Physician,Primary Care Service Line,Ralph H.Johnson and Sydney South West Area Health Service;Chairman ofthe
Veterans Affairs Medical Center,Charleston,South Carolina Board ofDirectors and Senior Director and Head ofResearch
Hypertension in the Elderly; Hypertensive Emergencies and Advisory Unit,The George Institute for International Health,
Urgencies Sydney,Australia
Cerebrovascular Disease in Hypertension
Grzegorz Bilo,MD,PhD
Research Assistant,Department ofClinical Medicine and Shalini Chandra,MD
Prevention,University ofMilano-Bicocca,Milan,Italy;I Department ofInternal Medicine,Wayne State University
Cardiac Department,Jagiellonian University,Krakow,Poland School ofMedicine,Detroit,Michigan
Secondary Hypertension: Sleep Apnea Hypertension in African Americans
viii Contributors
Neil Chapman,BSc,MB BChir Larry E.Fields,MD,MBA,FACP
Honorary Senior Lecturer,International Centre for Circulatory Director,Clinical Product Development,Medco Health
Health,Imperial College;Consultant,Cardiovascular Solutions,Inc.,Franklin Lakes,New Jersey
Physician,St.Mary’s Hospital,London,England U.S.and Canadian Guidelines for Hypertension
Cerebrovascular Disease in Hypertension
John M.Flack,MD,MPH,FAHA
Kenneth L.Choi,MD Professor and Associate Chair for Academic Affairs,Internal
Division ofNephrology and Hypertension,Department of Medicine Administration;Director ofCardiovascular
Internal Medicine,University ofMiami School ofMedicine, Epidemiology and Clinical Applications (CECA) Program,
Miami,Florida Wayne State University School ofMedicine,Detroit,
Kidney Disease in Hypertension Michigan
Hypertension in African Americans
Richard S.Cooper,MD
Professor and Chair,Department ofPreventive Medicine and Veronica Franco,MD,MSPH
Epidemiology,Loyola University Chicago Stritch School of Instructor ofMedicine,Division ofCardiovascular Disease,
Medicine,Chicago,Illinois University ofAlabama Birmingham School ofMedicine,
Genetics ofHypertension Birmingham,Alabama
Pathophysiology ofHypertension
Michael H.Criqui,MD,MPH
Professor ofMedicine and Vice Chair ofFamily and Stanley S.Franklin,MD,FACP,FACC,FASN
Preventive Medicine,University ofCalifornia,San Diego, Clinical Professor ofMedicine and Associate Medical
School ofMedicine,La Jolla,California Director ofthe UCI Heart Disease Prevention Program,
Peripheral Arterial Disease in Hypertension University ofCalifornia,Irvine,School ofMedicine,Irvine,
California
Errol D.Crook,MD The Special Problem ofIsolated Systolic Hypertension
Professor and Chairman,Department ofInternal Medicine,
Division ofNephrology,University ofSouth Alabama Ronald S.Freudenberger,MD
College ofMedicine,Mobile,Alabama Associate Professor ofMedicine,University ofMedicine &
Hypertension in African Americans Dentistry ofNew Jersey—Robert Wood Johnson Medical
School;Director,Heart Failure and Transplant Cardiology,
Prakash C.Deedwania,MD,FACC,FACP,FAHA Robert Wood Johnson University Hospital,New Brunswick,
Professor ofMedicine,University ofCalifornia,San New Jersey
Francisco,School ofMedicine,San Francisco;Chief, Heart Failure in Hypertension
Cardiology Section,Veterans Affairs Central California
Health Care System,Fresno,California William H.Frishman,MD
Hypertension in South Asians Rosenthal Professor and Chairman ofMedicine,New York
Medical College;Director ofMedicine,Westchester Medical
Mehul G.Desai,MD Center,Valhalla,New York
Medical Officer,Division ofCardiovascular and Renal (cid:3)-Blockers in Hypertension
Products,Center for Drug Evaluation and Research,Food
and Drug Administration,Silver Spring,Maryland Philip B.Gorelick,MD,MHP,FACP
Antihypertensive Drug Development: A Regulatory Perspective John S.Gavin Professor and Head,Department ofNeurology
and Rehabilitation,University ofIllinois College ofMedicine
Kim A.Eagle,MD,FACC at Chicago;Chief,Neurology Service,University ofIllinois at
Albion Walter Hewlett Professor ofInternal Medicine, Chicago Medical Center,Chicago,Illinois
University ofMichigan Medical School;Clinical Director, Assessment ofHypertensive Target Organ Damage
University ofMichigan Cardiovascular Center,Ann Arbor,
Michigan Guido Grassi,MD
Hypertension and the Perioperative Period Professor ofMedicine,University ofMilano-Bicocca,Milan;
Ospedale San Gerardo,Monza,Italy
William J.Elliott,MD,PhD European,American,and British Guidelines: Similarities and
Professor ofPreventive Medicine,Internal Medicine,and Differences
Pharmacology,Rush Medical College ofRush University at
Rush University Medical Center,Chicago,Illinois Carlene M.Grim,MSN,SpDN
Secondary Hypertension: Renovascular Hypertension; The President,Shared Care Research and Education Consulting,
Natural History ofUntreated Hypertension; Angiotensin Inc.,Milwaukee,Wisconsin
Receptor Blockers; (cid:2)-Blockers Office Blood Pressure Measurement
Bonita Falkner,MD Clarence E.Grim,MD,MS
Professor ofMedicine and Pediatrics,Thomas Jefferson Clinical Professor ofMedicine and Professor ofEpidemiology,
University,Philadelphia,Pennsylvania Medical College ofWisconsin,Milwaukee,Wisconsin
Hypertension in Children and Adolescents Office Blood Pressure Measurement
Contributors ix
Ehud Grossman,MD Philip R.Liebson,MD,FACC,FAHA
Vice Dean ofthe Faculty ofMedicine,Sackler School of McMullan-Eybel Chair ofExcellence in Clinical Cardiology,
Medicine,Tel-Aviv University,Tel-Aviv;Head ofInternal Professor ofInternal Medicine,and Professor ofPreventive
Medicine and Hypertension,Chaim Sheba Medical Center, Medicine,Rush Medical College ofRush University;Senior
Tel-Hashomer,Israel Attending Physician,Rush University Medical Center,
Rare and Unusual Forms ofHypertension Chicago,Illinois
Assessment ofHypertensive Target Organ Damage
Rajeev Gupta,MD
Professor ofMedicine,Mahatma Gandhi National Institute Donald M.Lloyd-Jones,MD,ScM
ofMedical Sciences;Consultant Physician,Marilek Hospital Assistant Professor ofPreventive Medicine and Assistant
and Research Center,Jaipur,India Professor ofMedicine (Cardiology),Northwestern University
Hypertension in South Asians Feinberg School ofMedicine;Associate in Medicine,
Northwestern Medical Faculty Foundation,Northwestern
David J.Hyman,MD,MPH Memorial Hospital,Chicago,Illinois
Professor ofMedicine and Family and Community Epidemiology ofHypertension
Medicine,Baylor College ofMedicine;Chief,General
Internal Medicine,Ben Taub General Hospital,Houston, Carolina Lombardi,MD,PhD
Texas Assistant Professor,University ofMilano-Bicocca;Head of
Hypertension in Hispanics Sleep Medicine Unit,San Luca Hospital,Milan,Italy
Secondary Hypertension: Sleep Apnea
Joseph L.Izzo,Jr.,MD
Professor ofMedicine,Pharmacology,and Toxicology,State Giuseppe Mancia,MD
University ofNew York at Buffalo School ofMedicine and Professor ofMedicine,University ofMilano-Bicocca,Milan;
Biomedical Sciences;Vice Chair,Department ofMedicine, Head ofInternal Medicine Division,Ospedale San Gerardo,
Erie County Medical Center,Buffalo,New York Monza,Italy
Assessment ofHypertensive Target Organ Damage Secondary Hypertension: Sleep Apnea; European,American,
and British Guidelines: Similarities and Differences
Panagiotis Kokkoris,MD
Endocrinologist,Department ofEndocrinology,Diabetes,and Franz H.Messerli,MD
Metabolism,Hellenic Air Force General Hospital,Athens,Greece Director,Hypertension Program,St.Luke’s-Roosevelt
Obesity in Hypertension Hospital Center,New York,New York
Rare and Unusual Forms ofHypertension
John B.Kostis,MD
John G.Detwiler Professor ofCardiology,Professor of Albert Mimram,MD
Medicine and Pharmacology,and Chairman,Department of Professor and Head,Medicine and Hypertension Service,
Medicine,University ofMedicine & Dentistry ofNew University ofMontpelier;Medicine and Hypertension
Jersey—Robert Wood Johnson Medical School;Chiefof Service,Hôpital Lapeyronie,Montpelier,France
Medical Service,Robert Wood Johnson University Hospital, Assessment ofHypertensive Target Organ Damage
New Brunswick,New Jersey
Heart Failure in Hypertension Marvin Moser,MD,FACP
Clinical Professor ofMedicine,Yale University School of
Jane Morley Kotchen,MD,MPH Medicine,New Haven,Connecticut
Professor ofEpidemiology,Medical College ofWisconsin, Diuretic Therapy in Cardiovascular Disease
Milwaukee,Wisconsin
Defining Hypertension Maryann N.Mugo,MD
Department ofInternal Medicine,University of
Theodore A.Kotchen,MD Missouri–Columbia School ofMedicine,Columbia,
Professor ofMedicine and Epidemiology and Associate Dean Missouri
for Clinical Research,Medical College ofWisconsin, Hypertension and Diabetes Mellitus
Milwaukee,Wisconsin
Defining Hypertension Samar A.Nasser,PAC,MPH
Department ofInternal Medicine,Wayne State University
John C.LaRosa,MD School ofMedicine,Detroit Michigan
President and Professor ofMedicine,State University ofNew Hypertension in African Americans
York Downstate Medical Center,Brooklyn,New York
Dyslipidemia in Hypertension Bruce Neal,MB ChB,PhD,MRCP
Associate Professor ofMedicine,University ofSydney
Daniel Levy,MD Faculty ofMedicine;Senior Director,Research and
Professor,Boston University School ofMedicine,Boston; Development,The George Institute for International Health;
Director,National Heart,Lung,and Blood Institute’s Honorary Consultant Epidemiologist,Royal Prince Alfred
Framingham Heart Study,Framingham,Massachusetts Hospital,Sydney,Australia
Epidemiology ofHypertension Meta-analyses ofHypertension Trials
x Contributors
James D.Neaton,PhD Priya G.Rao,DO
Professor ofBiostatistics,School ofPublic Health,University Department ofInternal Medicine,University of
ofMinnesota,Minneapolis,Minnesota Missouri–Columbia School ofMedicine,Columbia,Missouri
Design ofOutcome Studies Hypertension and Diabetes Mellitus
Suzanne Oparil,MD Shakaib U.Rehman,MD
Professor ofMedicine and Physiology and Biophysics, Associate Professor ofMedicine,Medical University ofSouth
University ofAlabama Birmingham,School ofMedicine; Carolina;Physician Manager,Primary Care,Ralph H.Johnson
Senior Scientist,Center for Aging,and Director,Vascular Veterans Affairs Medical Center,Charleston,South Carolina
Biology and Hypertension Program,University ofAlabama Hypertensive Emergencies and Urgencies
Birmingham,Birmingham,Alabama
Pathophysiology ofHypertension James J.Reidy,MD
Professor ofOphthalmology and Director ofthe Cornea
Gianfranco Parati,MD Service,State University ofNew York at Buffalo School of
Professor ofMedicine,Department ofClinical Medicine and Medicine and Biomedical Sciences;Clinical Director,
Prevention,University ofMilano-Bicocca;Head,II Department ofOphthalmology,Erie County Medical Center,
Cardiology Unit,San Luca Hospital,Milan,Italy Buffalo,New York
Secondary Hypertension: Sleep Apnea Assessment ofHypertensive Target Organ Damage
Valory N.Pavlik,PhD Clive Rosendorff,MD,PhD,DScMed
Associate Professor,Department ofFamily and Community Professor ofMedicine,Mount Sinai School ofMedicine,New
Medicine,Baylor College ofMedicine,Houston,Texas York;Physician,James J.Peters Veterans Affairs Medical
Hypertension in Hispanics Center,Bronx,New York
Ischemic Heart Disease in Hypertension
Thomas G.Pickering,MD,DPhil
Professor ofMedicine,Columbia University College of John F.Setaro,MD
Physicians and Surgeons;Director,Behavioral Associate Professor ofMedicine,Section on Cardiovascular
Cardiovascular Health and Hypertension Program, Medicine,Yale University School ofMedicine,New Haven,
Columbia Presbyterian Medical Center,New York, Connecticut
New York Resistant Hypertension
Home Monitoring ofBlood Pressure
Tariq Shafi,MD
Paul Pisarik,MD,MPH Assistant Professor,Clinical Internal Medicine,Wayne State
Assistant Professor,Department ofFamily Medicine,University University School ofMedicine,Detroit,Michigan
ofOklahoma College ofMedicine,Tulsa,Oklahoma Hypertension in African Americans
Hypertension in Hispanics
Alexander M.M.Shepherd,MD,PhD
F.Xavier Pi-Sunyer,MD,MPH Professor and Chief,Division ofClinical Pharmacology,
Professor ofMedicine,Columbia University College of University ofTexas Health Science Center at San Antonio,
Physicians and Surgeons;Chief,Division ofEndocrinology, San Antonio,Texas
Diabetes,and Nutrition,St.Luke’s–Roosevelt Hospital,New New and Investigational Drugs for Hypertension
York,New York
Obesity in Hypertension Domenic A.Sica,MD
Professor ofMedicine,Medical College ofVirginia at Virginia
Tiina Podymow,MD Commonwealth University;Chairman,Section ofClinical
Associate Professor,McGill University Faculty ofMedicine; Pharmacology and Hypertension,Virginia Commonwealth
Division ofNephrology,Royal Victoria Hospital,Montreal, University Health Systems,Richmond,Virginia
Quebec,Canada Diuretic Therapy in Cardiovascular Disease; Angiotensin-
Hypertension in Pregnancy Converting Enzyme Inhibitors
James L.Pool,MD James R.Sowers,MD,FACE,FACP,FAHA
Professor ofMedicine and Pharmacology and the James L. Associate Dean for Clinical Research and Professor of
Pool Endowed Chair in Clinical Pharmacology,Baylor Internal Medicine,Physiology,and Pharmacology,University
College ofMedicine;Director,Hypertension-Clinical ofMissouri–Columbia School ofMedicine,Columbia,
Pharmacology Research Clinic,Department ofMedicine, Missouri
Baylor College ofMedicine,Houston,Texas Hypertension and Diabetes Mellitus
(cid:2)-Blockers
Norman Stockbridge,MD,PhD
Jason Ramos,MD Director,Division ofCardiovascular and Renal Products,
Department ofInternal Medicine,Wayne State University Center for Drug Evaluation and Research,Food and Drug
School ofMedicine,Detroit,Michigan Administration,Silver Spring,Maryland
Hypertension in African Americans Antihypertensive Drug Development: A Regulatory Perspective
Contributors xi
Craig S.Stump,MD,PhD William B.White,MD
Assistant Professor ofMedicine,Division ofEndocrinology, Professor ofMedicine,University ofConnecticut School of
University ofMissouri–Columbia School ofMedicine; Medicine;Chief,Division ofHypertension and Clinical
Research Scientist,Harry S Truman Memorial Veterans Pharmacology,Calhoun Cardiology Center,and Medical
Hospital,Columbia,Missouri Director,Clinical Trials Unit,University ofConnecticut
Hypertension and Diabetes Mellitus Health Center,Farmington,Connecticut
Ambulatory Blood Pressure Monitoring in Hypertension
Sandra J.Taler,MD
Associate Professor ofMedicine,Mayo Medical School; Peter W.F.Wilson,MD
Consultant,Department ofInternal Medicine,Division of Professor ofMedicine,Department ofEndocrinology,
Nephrology and Hypertension,Mayo Clinic College of Diabetes,and Medical Genetics,Medical University ofSouth
Medicine,Rochester,Minnesota Carolina;Program Director,General Clinical Research
Transplant Hypertension Center,Charleston,South Carolina
Prediction ofGlobal Cardiovascular Risk in Hypertension
Robert Temple,MD
Associate Director for Medical Policy,Center for Drug Nathan D.Wong,PhD,MPH
Evaluation and Research,Food and Drug Administration, Professor and Director,Heart Disease Prevention Program,
Silver Spring,Maryland University ofCalifornia,Irvine,School ofMedicine,Irvine,
Antihypertensive Drug Development: A Regulatory Perspective California
Hypertension in East Asians and Pacific Islanders
Douglas C.Throckmorton,MD
Deputy Center Director,Center for Drug Evaluation and Xiaodong Wu,PhD
Research,Food and Drug Administration,Silver Spring, Assistant Professor,Department ofPreventive Medicine and
Maryland Epidemiology,Loyola University Chicago Stritch School of
Antihypertensive Drug Development: A Regulatory Perspective Medicine,Chicago,Illinois
Genetics ofHypertension
Fiona Turnbull,MB ChB,FAFPHM
Senior Research Fellow,The George Institute for William F.Young,Jr.,MD,MSc
International Health;Sydney,Australia Professor ofMedicine,Mayo Clinic College ofMedicine;
Meta-analyses ofHypertension Trials Vice-Chair,Division ofEndocrinology,Diabetes,
Metabolism,and Nutrition,Mayo Clinic,Rochester,
Carlos Vallbona,MD Minnesota
Distinguished Service Professor,Department ofFamily and Secondary Hypertension: Pheochromocytoma
Community Medicine,Baylor College ofMedicine;Chiefof
Staff,Community Health Program,Harris County Hospital Alberto Zanchetti,MD
District,Houston,Texas Emeritus Professor ofInternal Medicine,University of
Hypertension in Hispanics Milan;Scientific Director,Instituto Auxologico Italiano,
Milan,Italy
Donald G.Vidt,MD Calcium Channel Blockers in Hypertension
Consultant,Department ofHypertension and Nephrology,
Cleveland Clinic Foundation,Cleveland,Ohio
Hypertensive Emergencies and Urgencies
xiii
Foreword
Hypertension has been recognized as an important cardiovas- enormous amount has been learned about the mechanisms of
cular disorder since the dawn ofthe 20th century,when Riva- action and efficacy of the numerous classes of antihyperten-
Rocci and then Korotkoffdescribed the sphygmomanometric sive agents. For the first time, rigorous comparisons among
method of measuring arterial pressure. Although hyperten- these classes have been conducted.Revised practice guidelines
sion has been studied intensively since then,this is an extraor- that synthesize much useful information for clinical practice
dinary time for investigators, teachers, and clinicians in the have become available.
field.It is a time when hypertension is spreading to the devel- The goal of the Companions to Heart Disease: A Textbook
oping world and is reaching pandemic proportions. More of Cardiovascular Medicine is to provide cardiologists and
inclusive definitions as well as more accurate and detailed trainees in this field with important additional information in
measurements of blood pressure indicate that the prevalence critically important segments of cardiology that go beyond
of hypertension is even greater in the United States and what is contained in the “mother book,”thereby creating an
Europe than had previously been thought. Also, the health extensive cardiovascular information system. Hypertension,
threat of hypertension in the pathogenesis of coronary heart brilliantly edited by Drs.Henry R.Black and William J.Elliott
disease,heart failure,cerebrovascular disease,peripheral vas- and superbly written by distinguished leaders in the field,
cular disease, and renal failure probably exceeds what we clearly accomplishes this goal. We are delighted to welcome
appreciated in the past. this companion into the “family.”
At the same time,this is a time of unprecedented oppor- Eugene Braunwald
tunity to deal effectively with this serious health problem. Douglas P.Zipes
Research carried out in the last 5 years is unraveling the patho- Peter Libby
genesis and genetics of hypertension. Simultaneously, an Robert O.Bonow
xv
Preface
Hypertension is one of the most important public health Chronic kidney disease,an independent risk factor for cardio-
problems worldwide, and its impact is expected to increase vascular disease, too often results in end-stage renal disease
over the next 20 years as economically developing nations (dialysis or kidney transplantation), which has the highest
improve sanitation, infant mortality, and childhood immu- annualized per-patient cost ofany program supported by the
nization rates (among other measures).1 The prevalence of Centers for Medicare and Medicaid Services. Although dia-
hypertension in adults is expected to grow from 26.4% betes has typically ranked first among sole “causes”ofdialysis
(in 2000) to 29.2% in 2025, with most of the growth from for about 20 years,hypertension has ranked second for about
972 million to the projected 1.56 billion affected people the same period oftime,and,when more than one cause was
occurring outside ofNorth America and Europe.1This global allowed to be cited,hypertension was either the primary or a
“epidemic” of high blood pressure is expected to shift the secondary cause of end-stage renal disease in 72% of those
burden of disease so that heart disease will become the most who began dialysis in 2003.10Hypertension ranks second (to
common cause ofdeath worldwide by the year 2025.2 diabetes) as a cause of peripheral vascular disease, the most
In the United States, hypertension is the most important common cause oflower limb amputations in 2003.4Although
and most ubiquitous risk factor for heart disease and stroke, its relationship to hypertension is often forgotten, vascular
which were the number 1 and number 3 killers in preliminary dementia ranked eighth among the top 10 causes of death in
data from the year 2004,3 regardless of whether other risk the United States in 20043and second (to Alzheimer’s disease)
factors are present.4Approximately 60 million Americans have as a cause for nursing home placement.
hypertension, which includes those whose blood pressure is The two major reasons for the increased prevalence of
140 mm Hg or higher systolic or 90 mm Hg diastolic and hypertension in the United States are aging and increasing
those who are taking antihypertensive medications;an addi- weight of the population.These disproportionately affect the
tional 5 million persons have been told twice by a health care two ends ofthe age spectrum.The fastest-growing segment of
provider that their blood pressures were elevated and are the U.S.population is the “old old,”that is,those aged 85 years
counted as “hypertensive” in some surveys.4,5 High blood and older.11 The prevalence of hypertension in these indi-
pressure was given as a primary or contributing cause ofdeath viduals is thought to be more than 95%,because data from the
in about 11% of the death certificates filed in 20034 and Framingham Heart Study put the lifetime risk of hyper-
ranked 13th among primary causes of death in preliminary tension (beginning at either age 55 or 65 years) at more
data from 2004.3The importance ofhypertension among the than 90%.12The current nationwide epidemic of obesity and
living can also be ascertained from the preliminary 2004 physical inactivity, particularly among children and adoles-
National Ambulatory Medical Care Survey, which indicated cents, makes it likely that hypertension will become even
that hypertension was the most common diagnosis for a more prevalent as these overweight individuals grow into
chronic disease among all outpatients: the ICD-9 code for adulthood.13
hypertension (401) was listed in more than 42 million medical The estimated cost of hypertension and its treatment
office visits.6 ($63.5 billion) in the United States in 2006 is but a small part
The major reason why hypertension is so important,how- of the total cost of cardiovascular disease ($403.1 billion).4
ever,is not because ofthe deaths or health care provider visits The National Committee for Quality Assurance estimates that
that are directly attributed to it. Hypertension is the most in 2005,if blood pressures had been better controlled,many
widespread risk factor for many other diseases and illnesses, cardiovascular events would have been prevented or delayed,
each of which carries a high morbidity and mortality rate. between 12,000 and 32,000 deaths would have been avoided,
Coronary heart disease, still the most common killer of and $328 million to $1 billion would have been saved.14Both
American men and women,has many risk factors,but one can direct costs ofhospitalization ($6.2 billion) and nursing home
make a persuasive case that, on a nationwide population- care ($3.9 billion), as well as the indirect costs ($16 billion,
attributable basis, hypertension is currently more important consisting primarily of lost productivity,disability payments,
than smoking, diabetes, or dyslipidemia.4 Some believe that and death benefits) would be considerably reduced. The
one of the major reasons for the decline in deaths from both major driver of the increased cost of hypertension in the
coronary heart disease and stroke during the past 30 years is United States over the last 15 years has been the cost of anti-
the better and more effective treatment of hypertension.7 hypertensive drugs,which has risen at more than seven times
Hypertension is the risk factor with the highest population- the inflation rate. The rate of rise will probably decrease
attributable risk for stroke in the United States.8Heart failure, somewhat in the near future,as most of the commonly used
the most common discharge diagnosis from short-stay,acute- antihypertensive drugs will become available in generic for-
care hospitals for Medicare beneficiaries across the United mulations.The economics of hypertension and its treatment
States, is preceded in about 85% of cases by hypertension.9 vary widely across nations, in part because some countries
xvi Preface
have national formularies that restrict access to expensive analysis,in Section 5.The various concomitant diseases that
drugs.In some countries,even inexpensive generic formula- are often seen in hypertensive patients are summarized in
tions ofantihypertensive drugs are beyond the means ofmany Section 6. Hypertension has many “special populations and
patients,which is one of the challenges in controlling hyper- special situations”that are discussed in Section 7.The future
tension worldwide.2 ofhypertension treatment is considered in Section 8,and the
In this book, we have attempted to gather chapters that book ends with a discussion ofhypertension guidelines (from
cover the most important topics in hypertension,written by several different points ofview) in Section 9.
world authorities in each case.We have attempted not to avoid
some ofthe current controversies in hypertension but to allow William J.Elliott,MD,PhD
each author to present his or her point of view,with an eye Henry R.Black,MD
toward a balanced and objective result.
The discerning reader will recognize that several of the
References
“hot topics”in hypertension are mentioned but not dealt with
in detail,for reasons ofspace and because these controversies 1. Kearney PM,Whelton M,Reynolds K,et al.Global burden of
can be more effectively presented in other arenas, including hypertension:Analysis ofworldwide data.Lancet.2005;365:
the very recent medical literature. For example, the growing 217-223.
2. Ezzati M,Lopez AD,Rodgers A,et al.Selected major risk
awareness of the necessity of assessing global risk in a hyper-
factors and global and regional burden ofdisease.Lancet.
tensive patient before embarking on treatment has been skill-
2002;360:1347-1360.
fully promoted15 and adopted in most of Europe16 but not
3. Miniño AM,Heron M,Smith BL.Deaths:Preliminary data for
accepted in practice in the most recent U.S. guidelines.17
2004.National Center for Health Statistics,Centers for Disease
Similarly,JNC 7 recommends an initial thiazide-type diuretic Control and Prevention,2006.Found on the Internet at
for “most” patients with stage 1 hypertension and no com- http://www.cdc.gov/nchs/products/pubs/pugd/hestats.prelimde
pelling indication for a different class of drug17; the recent aths04/preliminarydeaths04.htm,accessed 25 JUN 06.
British National Institute for Health and Clinical Excellence 4. Thom T,Haase N,Rosamond W,et al.Heart disease and stroke
(NICE) guidelines instead recommend either an ACE statistics—2006 update:A report from the American Heart
inhibitor (for young white patients) or a calcium antagonist Association Statistics Committee and Stroke Statistics
(for black or older patients).18 The NICE guidelines recom- Subcommittee.Circulation.2006;113:85-151.
mend a β-blocker only for fourth-line treatment of hyper- 5. Fields LE,Burt VL,Cutler JA,et al.The burden ofadult
hypertension in the United States 1999 to 2000:A rising tide.
tension, based on their economic analyses and a recent
Hypertension.2004;44:398-404.
meta-analysis19;the low opinion ofthis class ofdrug is shared
6. Burt CW,McCaig LF,Rechtsteiner EA.Ambulatory medical
by neither JNC 7 nor the author of this book’s chapter on care utilization estimates for 2004.National Center for Health
β-blockers. The debate about the clinical importance of Statistics,Centers for Disease Control and Prevention,2006.
incident diabetes during drug treatment of hypertension has Found on the Internet at:http://www.cdc.gov/nchs/products/
intensified since these chapters were written,20,21 but a brief pubs/pubd/hestats/estimates2004/estimates04.htm,accessed 25
review and salient references can be found in the appropriate JUN 06.
chapters in this book.Whether certain classes ofantihyperten- 7. Braunwald E.Shattuck Lecture:Cardiovascular medicine at the
turn ofthe millennium:Triumphs,concerns and opportunities.
sive drugs have “benefits beyond blood pressure control” is
still debated,22-24but some aspects of this controversy can be N Engl J Med.1997;337:1360-1369.
8. Gorelick PB,Sacco RL,Smith DB,et al.Prevention ofa first
found in the chapters found within these covers.
stroke:A review ofguidelines and a multidisciplinary consensus
We have attempted to edit the submitted chapters to make
statement from the National Stroke Association.JAMA.1999;
them as balanced,fair,and objective as possible,while trying 281:1112-1120.
to retain some ofthe opinion and flavor ofthe authors’points 9. Levy D,Larson MG,Vasan RS,et al.The progression from
of view. We recognize, however, that errors may have crept hypertension to congestive heart failure.JAMA.1996;275:
into the text, but we hope the reader will understand that 1557-1562.
these were inadvertent and unintentional.Similarly,in a book 10. United States Renal Data System.2003 Annual Report.Figure
ofthis scope and magnitude,there will,ofnecessity,be omis- 2.9.Found on the Internet at:http://www.usrds.org/slides.htm.
Accessed 25 JUN 06.
sions of important references and shortened summaries of
11. Meyer J.Age:2000 (A Census 2000 Brief;C2KBR/01-12).
some individuals’opinions.We regret that it was not possible
US Department ofCommerce:Economics and Statistics
to make this book as all-encompassing as everyone would
Administration:US Census Bureau,October,2001.Found
wish. The decisions to omit some aspects of hypertension-
on the Internet at:http://www.census.gov/prod/2001pubs/
related data were those ofthe authors and editors,and we take c2kbr01-12.pdf.Accessed 15 JUN 06.
full responsibility for these. 12. Vasan RS,Beiser A,Seshadri S,et al.Residual lifetime risk for
We have attempted to organize the book along classical developing hypertension in middle-aged women and men:The
lines.Section 1 deals with the epidemiology and pathophysi- Framingham Heart Study.JAMA.2002;287:1003-1010.
ology of hypertension.Section 2 is concerned with diagnosis 13. Ogden CL,Carroll MD,Curtin LR,et al.Prevalence of
(including secondary hypertension) and is much longer than overweight and obesity in the United States,1999-2004.JAMA.
2006;295:1549-1555.
an analogous book would have been some 20 years ago
14. National Committee for Quality Assurance.The State ofHealth
because of the emerging data about ambulatory and home
Care Quality,2005.Washington,DC,2005,p.12.Found on the
blood pressure monitoring. Risk stratification is the major
Internet at www.ncqa.org/Docs/SOHCQ_2005.pdf.Accessed 25
theme ofSection 3,whereas the usual treatment options (both
JUN 06.
lifestyle modifications and drugs) are presented in Section 4. 15. Jackson R,Lawes CMM,Bennett DA,et al.Treatment with
Outcome studies are discussed,both in design and in meta- drugs to lower blood pressure and blood cholesterol based on