MANUAL
OF
HYPERTENSION

 

M. Mohsen Ibrahim, MD
Professor of Cardiology - Cairo University
President of the Egyptian Hypertension Society
Principal Investigator of the Egyptian
National Hypertension Project.

PREFACE

Hypertension is a major public health problem in many parts of the world. It has been identified as the most common, most potent and most universal contributor to cardiovascular mortality. The disease carries special importance for a number of reasons.

First: It has been found that hypertension is the commonest cause of doctors’ consultations in many western countries. In most parts of the world its prevalence varies between 10-30% of population and it increases with old age.

Second: Hypertension if left uncontrolled without treatment can lead to disastrous sequelae. High blood pressure damages the heart, the kidneys, the brain and the aorta producing heart failure, renal failure, strokes and aortic dissection. It is a major risk factor for coronary artery disease and premature atherosclerosis.

Third: High blood pressure can be treated. Control of hypertension can prevent most of the previous complications. Available antihypertensive medications can control even severe cases.

Fourth: The identification and management of hypertension is misunderstood and has been surrounded by a number of false beliefs shared by both the public and medical profession. Hypertension is not nervousness and should not be equated with headache or dizziness. It is in the majority of cases a silent disease without symptoms. It should be treated with specific antihypertensive therapy and not by tranquilizers. It can be present in quiet, relaxed, emotionally stable persons. Antihypertensive medications should be continued for the rest of patient’s life. Since the etiology of essential hypertension is not known, therapy is directed to the symptomatic level of mere lowering of blood pressure. Discontinuation of therapy should lead to recurrence of hypertension and rise of blood pressure. There is no cure from established essential hypertension except in the unfortunate patients who develop cerebral stroke or myocardial infarction.

Systolic hypertension is equally important as diastolic hypertension. Furthermore, cardiac and cerebral complications are related more to the level of systolic than the diastolic blood pressure.

The aim of this manual is to provide the medical student and the practitioner with a short practical review of hypertension. It addresses the everyday clinical problems and is written in a simple language that suits the beginner. The book is not intended to be a detailed textbook. Stress has been made all through the book on the practical issues avoiding theoretical and controversial issues. This manual is based upon both the author’s personal experience in the management of hypertensive patients over the past 30 years and the review of the current world literature in the field of hypertension.

Cairo, August 2001

TABLE OF CONTENTS

Chapter 1: Hypertension - An Overview      

Chapter 2: Hypertension: Definition, Classification and  Pathophysiologic Mechanisms 

Chapter 3: Measurement of Blood Pressure

Chapter 4: Clinical Evaluation of Hypertensive  Patients

Chapter 5: Laboratory Evaluation of Hypertensive Patients 

Chapter 6: Antihypertensive Drugs 

Chapter 7: Inititation and Monitoring  of Antihypertensive Therapy 

Chapter 8: Non-Pharmacologic Therapy: Lifestyle  Modification

Chapter 9: Hypertension in Special Groups 

Chapter 10: Renal Artery Stenosis   

Chapter 11: Primary Aldosteronism 

Chapter 12: Hypertensive Emergencies        

Chapter 13: Resistant Hypertension

Chapter 14: Patient Education           

Chapter 15: Epidemiology of Hypertension in Egypt