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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  • Classify blood pressure (BP) levels and treatment goals.

  • Recognize underlying causes and contributing factors in the development of hypertension.

  • Describe the appropriate measurement of BP.

  • Recommend appropriate lifestyle modifications and pharmacotherapy for patients with hypertension.

  • Identify populations requiring special consideration when designing a treatment plan.

  • Construct an appropriate monitoring plan to assess hypertension treatment.

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KEY CONCEPTS

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  • Image not available. Hypertension is widely prevalent and significantly contributes to cardiovascular morbidity, mortality, and associated healthcare costs.

  • Image not available. The cause of hypertension is unknown in the majority of cases (primary hypertension), but for patients with secondary hypertension, specific causes can be identified.

  • Image not available. Patients failing to achieve goal blood pressure (BP) despite adherence to optimal doses of three distinct antihypertensive agents (ideally, one being a diuretic) have resistant hypertension and should be evaluated for secondary causes of hypertension.

  • Image not available. The pathophysiology of primary hypertension is heterogeneous but ultimately exerts its effects through the two primary determinants of BP: cardiac output (CO) and peripheral resistance (PR).

  • Image not available. Appropriate technique in measuring BP is a vital component to the diagnosis and continued management of hypertension.

  • Image not available. Drug selection for the management of patients with hypertension should be considered as adjunctive to nonpharmacologic approaches for BP lowering, and ultimately the attainment of target BP in many cases may be more important than the antihypertensive agent used.

  • Image not available. Implementation of lifestyle modifications successfully lowers BP, often with results similar to those of therapy with a single antihypertensive agent.

  • Image not available. An approach to selection of drugs for the treatment of patients with hypertension should be evidence based. Consideration should be given to the individual's comorbidities, co-prescribed medications, and practical patient-specific issues including costs.

  • Image not available. Specific antihypertensive therapy is warranted for certain patients with comorbid conditions that may elevate their level of risk for cardiovascular disease (CVD).

  • Image not available. The frequency of follow-up visits for patients with hypertension varies based on individual cases but is influenced by the severity of hypertension, comorbidities, and choice of agent selected.

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INTRODUCTION

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Despite efforts to promote awareness, treatment, and the means available to aggressively manage high blood pressure (BP), trends over the past 15 years demonstrate only modest improvements in its treatment and control. National and international organizations continually refine their recommendations of how clinicians should approach the management of patients with high BP, and although approaches vary to some degree, there are clear themes that emerge regardless of which national or international organization's algorithm is followed. The purpose of this chapter is to (a) provide a summary of key issues associated with the management of patients with hypertension, (b) discuss the basic approach to treating patients with hypertension and provide a functional summary of the currently prevailing themes of national guidelines, and (c) summarize salient pharmacotherapeutic issues essential for clinicians to consider when managing patients with hypertension.

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Various algorithms recommend nonpharmacologic and pharmacologic management with the ...

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