Manual of Essential Hypertension Nihar Mehta
INDEX
Page numbers followed by b refer to box, f refer to figure, and t refer to table
A
Accelerated hypertension, treatment of 90, 90t
Accurate blood pressure
check-up 8
measurement 5
Acebutolol 48
Acetazolamide 45
Acromegaly 3
Acute coronary syndrome 77, 112
Adenosine triphosphatase 57
Adho mukha vrksasana 27
Adrenal 32
steroids 3
tumors 20
Adrenergic crisis 78
Advanced glycation end products 81
Alcohol 26
consumption, moderation of 130
Aldosterone 32, 32t
Aldosteronism, primary 3, 21
Aliskiren 35
Alpha-blockers 5355, 133, 136
Alpha-methyldopa 53, 55, 136
Ambulatory blood pressure
measurement 10, 10f, 11t
monitoring 2, 122
American College of Cardiology 1, 109
American Diabetes Association 80
American Heart Association 1, 109
Amiloride 43, 44
Amlodipine 3840, 75
Angina 135
Angioedema 33, 136
Angiotensin–converting enzyme inhibitors 3133, 39, 44, 67, 77, 82, 85, 90, 92, 102, 112, 113, 116, 118, 121, 133, 135, 136, 140
contraindications of 34, 34b
pharmacologic characteristics of 33, 33t
side effects of 33, 33b
Angiotensin-receptor blockers 31, 34, 34t, 39, 44, 82, 90, 96, 102, 112, 113, 116, 118, 121, 133, 135, 136, 140
Ankle brachial index 5, 21, 110
Antagonists 45
Antihypertensive 53, 118
classes of 53t
drugs 89t, 134, 134t, 135, 135t
major classes of 136, 136t
therapy 71, 133
Antinatriuresis 32
Aorta
coarctation of 20, 21
evaluation of 21
Aortic aneurysm, abdominal 1
Aortic dissection 4, 77
Aortic stenosis, severe 34
Apoptosis 32
Appetite suppressants 3
Aquaretics 4345
Arginine vasopressin receptor 43, 45
Arrhythmias 4, 20, 43
Arterial baroreceptors 60
Arterial vasodilator 105
Arteriovenous fistula 61
Artery, peripheral 19
Aspirin 138, 142
Asthma 116, 135
chronic obstructive pulmonary disease overlap syndrome 118
mild 50
severe 50
Asymptomatic hypertension-mediated target organ damage 111
Atenolol 48, 90
Atherogenesis 32
Atheroma formation 32
Atherosclerosis 32
Atherosclerotic cardiovascular disease 137, 138, 140
Atherosclerotic renal occlusion 20
Atrial fibrillation 4, 1921
Automated sphygmomanometer 6, 7f
Averapamil 135
Azilsartan 34
Azotemia 43
Back pain 59
B
Baroreceptor activation therapy 57
Benidipine 39
Beta-blockers 4850, 77, 112, 117
effects of 48
pharmacologic properties of 48, 48t
Bisoprolol 49
Blood pressure 1, 9f, 11t, 20, 24, 31, 32, 40, 57, 60, 65, 70, 71, 77, 81, 82, 88, 90, 94, 104, 111, 121, 129, 131, 132, 137
control of 112
diastolic 1, 2, 60, 70, 81, 82, 109, 113
high 1, 2t, 65, 131
low 31
lowering therapy, initiation of 132
management, perioperative 103
measurement 5, 9, 9t, 10, 141
monitoring 141
normal 1, 131
out-of-office measurement of 10
patterns of 11t
systolic 1, 2, 58, 60, 70, 81, 82, 109, 113
target of 141
Blood sugar 123
fasting 21, 133
Blood urea nitrogen 21, 132
Blurred vision scotoma 89
Body mass index 20, 25, 124, 131
Bradycardia 50
severe 50
Bradykinin 32, 33
degradation 32
Brain 19
Breathlessness 19
Bronchospasm 50
Bumetanide 43, 44
C
Café-au-lait patches 20
Calcium channel blocker 38, 38t, 77, 82, 85, 89, 104, 117, 133, 135, 140
long-acting 121
pharmacological properties of 39, 39t
Candesartan 34
Captopril 33, 75
Carbonic anhydrase inhibitors 45
Cardiac arrest, sudden 32
Cardiac fibrosis 32
Cardiomyopathy, hypertrophic obstructive 34
Cardiovascular disease 1, 4, 65, 80, 110, 132
Carotid
baroreceptor
activation therapy 60
stimulation therapy 138
femoral pulse wave velocity 5
intima-media thickness 5
plaques 4
revascularization 19
ultrasound 5
Carteolol 48
Carvedilol 49
Central aortic blood pressure 14
Central nervous system 50, 74, 89
Cerebral hemorrhage 89
Cerebrovascular accident 21, 80, 135
Cerebrovascular disease 4, 5, 70
Chest
pain 19
X-ray of 75
Chloride 43
Chlorthalidone 43, 44
Chronic obstructive pulmonary disease 116, 118
Cilnidipine 39
Claudication 19
worsening of 50
Clonidine 53, 75, 89, 136
Cocaine 3
Coffee contains caffeine 26
Cold
extremities 50
feet 136
hands 136
Community healthcare workers 140
Complete blood count 75
Computed tomography 5, 21, 22
scan 94
Conivaptan 43
Continuous positive airway pressure 125
Contraction, stimulation of 32
Convulsion 88
Coronary artery disease 19, 32, 112, 116, 131, 132, 137, 140
Cortical blindness 89
C-reactive protein 66
Creatinine 132
Cuff sizes 6t
Cushing syndrome 3, 21
features of 20
Cyclosporine 3
Cysts, renal 3
Cytochrome P 39
D
Death 80
Deep tendon reflex 91
Dementia 19
Depression 50
severe 50
Diabetes mellitus 12, 36, 50, 65, 80, 110, 131, 134, 135
acute complications of 80
type 1 81
type 2 65
Diabetic ketoacidosis 80
Dietary sodium 25
Dihydropyridine 38t, 39, 140
Diltiazem 38, 39, 135
Dimethylarginine
asymmetrical 96
dimethylamine hydrolase 96
Distal convoluted tubule 42, 43
Diuretics 42, 118, 133
classes of 43, 43t
pharmacological characteristics of 44, 44t
Dizziness 43
Doxazosin 53, 136
Drug therapy 29
Dry cough 33, 136
Dual renin–angiotensin–aldosterone system 112
Dysautonomia, familial 3
Dyslipidemia 50, 65, 111, 132, 134136
E
Echocardiogram 111
Eclampsia 88
treatment of 91
Edema 136
acute pulmonary 77
feet 19
peripheral 84
pulmonary 88
Efonidipine 39
Electrocardiogram 5, 75, 111, 133
Elevated jugular venous pressure 84
Enalapril 33, 76
Enalaprilat 33, 104
Endothelial dysfunction 32
Endothelin 96
Endothelium 32
Eplerenone 43, 44, 86
Eprosartan 34
Erectile dysfunction 19, 50
Erythropoietin 3
Esmolol 49, 76, 104
Estimated glomerular filtration rate 5, 21, 82, 98, 110, 111, 132
Estrogens, high-dose 3
European Society of Cardiology 1, 61, 109, 140
European Society of Hypertension 1, 140
Extracellular fluid 96
Eye 4, 19
F
Fatigue 50
Felodipine 39
Femoral artery pseudoaneurysm 59
Fenoldopam 104
Fibrinogen 32
Fibromuscular dysplasia 3, 20, 22
Fibrosis 32
Fimasartan 34
Frequent nocturnal hemodialysis 98
Fundoscopy 5, 20, 21
Furosemide 43, 44
G
Gangrene 19, 50
Glomerular fibrosis 32
Glomerular filtration rate 89, 95, 95f, 97
Glucocorticoid remediable hypertension 3
Glucose 136
intolerance 32
transport 66
Gordon syndrome 3
Gout 131, 134, 136
Guanabenz 53
Guanfacine 53
Guideline-directed medical therapy 86
H
Head, computed tomography of 75
Headache 19, 89, 136
Heart 19, 20, 32
block 50, 135
disease, ischemic 77, 109, 112, 112t
failure 1, 19, 43, 50, 54, 84, 85, 105, 131, 134, 135, 137, 140
acute 85
chronic 85
congestive 77, 136
with left ventricular ejection fraction 84
with preserved ejection fraction 4
with reduced ejection fraction 84, 142
worsening of 50
rate, irregular 142
sound 20
Hematocrit 132
Hemoglobin 132
glycosylated 21, 80, 133
Hemolysis, elevated liver enzymes, low platelet count 89
Hemorrhage
intracranial 70
subarachnoid 71
Henle loop 42
Hepatic dysfunction 89
High-density lipoprotein 50
cholesterol 65
Home blood pressure
measurement 10
monitoring 2, 13, 122
Hormone, antidiuretic 42
Hydralazine 53, 55, 76, 89, 91, 104, 136
Hydrochlorothiazide 43, 44
Hydroxyindoleacetic acid 75
Hydroxylase deficiency 3
Hydroxysteroid dehydrogenase deficiency 3
Hypercalcemia 3
Hyperglycemia 43, 136
Hyperinsulinemia 66
Hyperkalemia 33, 34, 135, 136
Hyperosmolar hyperglycemic state 80
Hypersensitivity 34
Hypertension 2, 10, 12f, 12t, 1821, 24, 25, 39, 43, 45, 65, 67, 70, 80, 84, 85, 88, 90, 91, 94, 97, 109, 116, 129, 131, 133, 136
association of 85
chronic 88
complications of 88, 88t
control 98
essential 20, 20t
gestational 88
management of 85, 97, 112, 116, 129
mediated organ damage 4, 1821, 132, 133, 140
evaluation of 4t
pathogenesis of 94
pathophysiology of 81
perioperative 101
pharmacotherapy for 133, 141
pregnancy-induced 77
prevalence of 116
primary 2
pseudoresistant 121, 122
refractory 122
resistant 60, 121, 122, 124b, 126b, 127, 136
risks of 4
screening for 14
secondary 2, 3, 20, 21, 21t
severe 74, 78
systemic 57, 109111, 112t
systolic 134, 135
treatment of 81
true resistant 121
Hypertensive crisis 43
Hypertensive emergency 74, 75, 78
drugs for 76t
Hyperthyroidism 3, 20
Hyperuricemia 43
Hyponatremia 33
Hypotension 34
orthostatic 33, 136
postural 136
Hypothalamus, paraventricular nucleus of 58
Hypothyroidism 3, 20
Hypovolemia 43
I
Impaired fasting glucose 82
Impaired glucose tolerance 82
Impotence 43, 136
Indapamide 43, 44
Indian Guidelines on Hypertension 1, 140
Insomnia 50
International Society of Hypertension 140
Interstitial fibrosis 32
Intracranial pressure 3, 77
Intraglomerular pressure 32
Irbesartan 34
Ischemic heart disease 77, 109, 112, 112t
prevalence of 109, 109t, 111
K
Kidney 19, 21, 32
disease 4, 5
chronic 4, 5, 12, 25, 36, 80, 94, 95, 95f, 97, 98, 132, 136, 137
palpable 20
sympathetic reinnervation of 59
K-sparing diuretics 43, 44
L
Labetalol 49, 71, 7578, 90, 103, 105
Lacidipine 40
Lactation 135
Lead poisoning 3
Left ventricular
dysfunction 33, 135
ejection fraction 33, 39
hypertrophy 4, 20, 21, 32, 85, 110, 111, 132
Lethargy 136
Liddle's syndrome 3
Lipid profile 75
derangements 43
Lisinopril 33
Liver
disease
acute 136
chronic 136
enzymes, elevated 89
failure 50
function test 75
Lixivaptan 43
Loop diuretics 4345
Losartan 34
Low-density lipoprotein 32, 138
cholesterol 111
Lower extremity artery disease 5
Lower limb Doppler 21
M
Magnesium 43
sulfate 91
Magnetic resonance
angiography 140
imaging 5, 21, 94
Meditation 27
Mercury sphygmomanometer 5, 6f
Metabolic syndrome 50, 65, 67, 135
Metanephrines 75
Methyldopa 89, 90
Metolazone 43, 44
Metoprolol 49
Microalbuminuria 4, 110
Mineralocorticoid receptor antagonists 35, 86, 133
Minoxidil 53, 55
Mitogen-activated protein kinase 66
Monoamine oxidase inhibitors 3, 78
Moxonidine 53
Multidrug therapy 57
Murmurs 20
Myocardial hypertrophy 32
Myocardial infarction 1, 19, 21, 32, 39, 85, 109, 110, 113
Myocyte hypertrophy 32
N
Nadolol 48
Nausea 43
Nebivolol 49
Nephron 42f
Nervous system 20
Neurofibromatosis, café-au-lait patches of 20
Neurologic hypertensive emergency 77
Neuropathy 80
Neutropenia 33
New York Heart Association 84
Classification for Heart Failure 84, 84t
Nicardipine 77, 104
Nifedipine 38, 39, 75, 8991
Nitinol device 139
Nitric oxide 49, 66, 96
Nitroglycerin 7678, 104, 105
Nitroprusside 77, 89, 104, 112
Nocturia 19
Nondihydropyridines 38t
Nonhealing wound 19
Nonpharmacological therapy 141
Nonsteroidal anti-inflammatory
agents 3
drugs 19, 22, 43
O
Obesity 65, 111
Obstructive airways disease 116, 118t
Obstructive sleep apnea 12, 21
Office blood pressure
classification of 2t
screening, frequency for 14t
Olmesartan 34
Oral contraceptive 19, 22
Organ system 88
Ototoxicity 43
Overweight 82
Oxidative stress 32
P
Palpitations 19
Parathyroid
disorders 21
hormone 22
Parenchymal diseases 3
Perindopril 33
Perindoprilat 33
Perioperative hypertension 101
etiology of 102
Peripheral arterial disease 20, 110
Peripheral vascular disease 1, 4, 50, 80, 135
severe 50
Pharmacological therapy 131
Pharmacotherapy 131133
initiation of 131
Phenoxybenzamine 53
Phentolamine 77
Pheochromocytoma 3, 20, 21, 75, 124
Plasma
aldosterone concentration 124
renin activity 124
Plasminogen activator inhibitor 66
Pneumatic sphygmomanometer 7, 7f
Polycystic kidney disease 3, 19, 20
Polyneuritis 3
Polyuria 19
Porphyria 3
Posterior reversible encephalopathy syndrome 77, 89
Postmyocardial infarction 34, 49, 135
Postprandial blood sugar 21, 133
Potassium 25, 32, 43, 132
sparing diuretics 45
Pranayama 27
Prazosin 53, 75, 136
Preeclampsia 88
Pregnancy 34, 88, 90, 90t, 135, 136
Prerenal azotemia 43
Prinzmetal angina 39, 50
Propranolol 48
Prostatic hypertrophy 136
Protein leak 32
Proteinuria 4, 32, 36, 89, 94, 135
Proximal convoluted tubule 42, 43
Pulse pressure 113
R
Radiofrequency 57
Ramipril 33
Ramiprilat 33
Raynaud's phenomenon 39, 50
Red blood cell 104
Renal artery
dissection 59
Doppler 75
stenosis 59
bilateral 34, 135
Renal cortical necrosis 89
Renal denervation 58b, 60, 61
symplicity catheter system for 59f
therapy 57
landmark trials of 60, 60t
Renal failure 33, 34, 50
Renal function
impaired 5
test 75, 123
Renal nerve denervation 125
Renal sympathetic denervation therapy 139
Renal sympathetic nervous system 58f
anatomy of 57
physiology of 57
Renal ultrasound 5
Renin-angiotensin aldosterone system 31, 66, 81, 82, 90, 94
blockers 112
Reserpine 53
Retinal therapies 19
Retinopathy 80
hypertensive 4, 5
Rostral ventrolateral medulla 58
S
Salt reduction 130
S-amlodipine 39
Satavaptan 43
Secondary hypertension 2, 3, 20, 21, 21t
causes of 3
etiology of 3t
Seizures 89
Sepsis 80
Serum sodium 132
Shavasana 27
Shirshasana 27
Shock, cardiogenic 50
Sinoatrial node 39
Skeletal muscles 66
Skin
necrosis 50
rashes 33
Sodium 32, 43
nitroprusside 76, 77, 105
potassium adenosine triphosphatase 97
pump 97
Solitary tract, nucleus of 58
Sotalol 48
Spinal cord section, acute 3
Spironolactone 43, 44, 86, 90
Spontaneous aneurysmal subarachnoid hemorrhage 71
Stenosis 4
Stroke 1, 19, 32, 80
hemorrhagic 4, 5
ischemic 4, 5, 70
Subcapsular bleeding 89
Subclinical hypertension-mediated organ damage 110
Sublingual nifedipine 71
Super oxide dismutase 96, 99
Sympatholytics, central 5355
Syncope 19
Systematic coronary risk evaluation system 110, 110t
T
Tachyarrhythmia 135
Tachycardia 142
Tachyphylaxis 106
Takayasu's disease 20
Target organ damage 74t
Taste disturbance 33
Telmisartan 34
Terazosin 53
Thiazides 4345, 90, 121
Thrombosis 32
Thyroid 21
disease, features of 20
function test 75
stimulating hormone 22
Thyroxine 22
Timolol 48
Tolvaptan 43, 44
Torsemide 43, 44
Trandolapril 33
Trandolaprilat 33
Transforming growth factor-beta 97
Transient ischemic attack 4, 5, 19, 71, 80, 110, 137
Triamterene 43, 44
Tricyclic antidepressants 3
Triiodothyronine 22
Tumors
necrosis factor alpha 66
renal 3, 20
U
Ultrasonography 21, 22, 94
Urinary tract infection 19, 59
Urinary vanillylmandelic acid 75
Urine
albumin 5
examination 75
V
Valsartan 34
Vascular disease 4, 5
Vasoconstriction 32
Vasodilators 53, 55, 136
Vasovagal reaction 59
Verapamil 38, 39, 89
Vertigo 19
Vision, blurring of 19
Visual hallucinations 50
W
Water retention 32
Weight 26
gain 50
loss 82
reduction 130
White-coat hypertension 12f, 12t, 122
World Health Organization 65, 129
Y
Yoga 27
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Chapter Notes

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Manual of Essential Hypertension
Manual of Essential Hypertension
Nihar Mehta MD DNB (Medicine) DNB (Cardiology) FRCP (London) FICP Consultant Interventional Cardiologist and Structural Heart Disease Specialist, Jaslok, Breach Candy, HN Reliance, Bhatia, St Elizabeth and KJ Somaiya Superspecialty Hospitals Mumbai, Maharashtra, India
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Manual of Essential Hypertension / Nihar Mehta
First Edition: 2023
9789389587388
Printed at:
All past, present and future patients suffering from hypertension
Hoping for better management and control
Contributors Preface
Manual of Essential Hypertension gives an in-depth understanding about high blood pressure, review of antihypertensive drugs in detail, and hypertension in various circumstances with one chapter dedicated to each special condition.
The aim is to publish a book for medical students and general physicians to help them manage hypertension effectively which even though is one of the most prevalent conditions globally and in India remains a leading cause for end organ damage due to its asymptomatic nature. Hence, in this book great emphasis has been put upon the practical aspects of diagnosis, screening, and follow-up in hypertensive management.
The management of hypertension has been emphasized through chapters on individual drugs as well as a chapter on the approach to a patient with high blood pressure. The section on special subsets gives an approach to manage high blood pressure in various clinical scenarios such as ischemic heart disease, heart failure, chronic kidney disease, respiratory disease, diabetes mellitus, obesity cerebrovascular disease, and pregnancy.
The book is written keeping in mind the medical students, hence, the MCQs and a short summary at the end of each chapter. Figures, tables, and images have been added for understanding and interpretation of various signs, symptoms, and investigations of patients and aid in their management.
Dr Amit A Saraf and Dr Ruchit Shah have contributed with chapters as well as being sectional editors. I would like to thank Dr Anand Bhabhor, Dr Nikesh Jain, Dr Amjad Khan, Dr Mitul A Shah, Dr Vibhor Pardasani, Dr Nimish Shah, Dr Shivani Kamat, Dr Sudhiranjan Dash Choudhury, Dr Srinivasan Narayanan, and Dr Nandhakumar Vasu for their valuable time and contribution to the book. Despite their busy schedules, they have given their best efforts to make this book a complete guide to daily blood pressure management. Special thanks to Dr Zakiya E Patni who has amalgamated the book by extensive proofreading in addition to the contribution to chapters.
My appreciation to the whole team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their patience, encouragement, and professionalism during the entire process. I am thankful to Shri Jitender P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra (Senior Director—Professional Publishing, Marketing, and Business Development), Ms Pooja Bhandari (Production Head), and Mr Anand Kumar (Development Editor) for wonderfully framing this book within a short duration.
Special thanks goes to my family Mrs Suman Kothari, Dr Shilpa Mehta, Mrs Labdhi Mehta, Keya, Kimaya, and Raahi for their never-ending support.
Nihar Mehta