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Abbreviations
ACE: angiotensin-converting enzyme
ACEI: angiotensin-converting enzyme inhibitor
Aldo: aldosterone
AngII: angiotensin II
ANP: atrial natriuretic peptide
ARB: angiotensin receptor blocker
AT1: type 1 receptor for angiotensin II
ATPase: adenosine triphosphatase
AV: atrioventricular
BB: β blocker
β blocker: β adrenergic receptor antagonist
BNP: brain natriuretic peptide
BP: blood pressure
CAD: coronary artery disease
CCB: Ca2+ channel blocker
CNS: central nervous system
COX-2: cyclooxygenase 2
DOPA: 3,4-dihydroxyphenylalanine
DRI: direct renin inhibitor
ENaC: epithelial Na+ channel
ESC: European Society of Cardiology
GI: gastrointestinal
GFR: glomerular filtration rate
HDL: high-density lipoprotein
HF: heart failure
HTN: hypertension
ISA: intrinsic sympathomimetic activity
ISDN: isosorbide dinitrate
JNC8: Eighth Joint National Committee
MI: myocardial infarction
MRA: mineralocorticoid receptor antagonist
NCC: NaCl cotransporter
NE: norepinephrine
NO: nitric oxide
NSAID: nonsteroidal anti-inflammatory drug
RAAS: renin-angiotensin-aldosterone system
RAS: renin-angiotensin system
SA: sinoatrial
SNS: sympathetic nervous system
VMAT2: vesicular catecholamine transporter 2
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EPIDEMIOLOGY AND TREATMENT ALGORITHMS
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Hypertension is the most common cardiovascular disease. Elevated arterial pressure causes hypertrophy of the left ventricle and pathological changes in the vasculature. As a consequence, hypertension is the principal cause of stroke; a major risk factor for CAD and its attendant complications, MI and sudden cardiac death; and a major contributor to heart failure, renal insufficiency, and dissecting aneurysm of the aorta. The prevalence of hypertension increases with age; for example, about 50% of people between the ages of 60 and 69 years old have hypertension, and the prevalence further increases beyond age 70. According to a recent survey in the U.S., 81.5% of those with hypertension are aware they have it, 74.9% are being treated, yet only 52.5% are considered controlled (Go et al., 2014). The success of hypertension treatment programs, such as one organized in a large integrated healthcare delivery system in the U.S. (Jaffe et al., 2013), show that these figures can be substantially improved by electronic hypertension registries tracking hypertension control rates, regular feedback to providers, development and frequent updating of an evidence-based treatment guideline, promotion of single-pill combination therapies, and follow-up blood pressure checks. Between 2001 and 2009, this program increased the number of patients with a diagnosis of hypertension by 78%, as well as the proportion of subjects meeting target blood pressure goals from 44% to more than 84% (Jaffe et al., 2013).
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Hypertension is defined as a sustained increase in blood pressure of 140/90 mmHg or higher, a criterion that characterizes a group of patients whose risk of hypertension-related cardiovascular disease is high enough to merit medical attention. Actually, the risk of both fatal and nonfatal cardiovascular disease in adults is lowest with systolic blood pressures of less than 120 mmHg and diastolic blood pressures less than 80 mmHg; these risks increase incrementally as systolic and diastolic blood pressures rise. Recognition of this continuously increasing risk prevents a simple definition of hypertension (Go et al., 2014) ...