Blood Pressure Monitoring in Cardiovascular Medicine and Therapeutics / Edition 1

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Although elderly hypertensive patients are the subjects of the largest body of outcomes trial data, as a group they are not getting the maximum benefit from antihypertensive medications. In Hypertension in the Elderly, a panel of leading academic physicians comprehensively reviews all aspects of this problem using the most current clinical data. Topics range from basic concepts, epidemiology and trials, and evaluation and management, to pharmacological treatment, special populations, and adherence, all presented with an emphasis on the optimal management of patients. The authors examine in detail the mechanisms of hypertension in the elderly, particularly age-related changes in vascular stiffness, and methodically review the lifestyle and outcomes trials that were conducted in older persons. The problems of clinical evaluation, secondary hypertension, and target organ damage are also fully addressed, and a practical approach is provided for correctly determining blood pressure, one of the most important tasks in evaluating an older patient. Extensive discussions of pharmacological therapy detail the role of individual drug classes, including diuretics and [beta]-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium antagonists, [alpha]-I blockers, and combination drug therapies. Additional chapters focus on special populations, such as African Americans, patients with diabetes, and patients with arthritis, as well as on the clinician's role in improving therapeutic adherence in older patients.

Features: Standard reference on the diagnosis and treatment of hypertension in the elderly, Full use of the most current clinical data available,Extensive discussion of all the major pharmacological therapies, Treatment guidelines for African Americans and patients with diabetes and arthritis, Help in improving therapeutic adherence in older patients.

The book contains black-and-white illustrations.

This pioneering book covers the new topic of circadian variation in cardiovascular disease, with a special emphasis on hypertension. New techniques in the self and ambulatory monitoring of blood pressure and heart rate have led to marked improvements in our ability to detect various clinical entities in patients with hypertension and vascular diseases. These techniques and their interpretation are covered in this book. Section I describes the methodology of self and ambulatory blood pressure monitoring in research and clinical practice. Section II describes the advances in the understanding of the pathophysiology of the circadian biology of cardiovascular disorders. This section is of intense importance since it has been shown that ambulatory blood pressure values are independent predictors of cardiovascular morbidity and mortality. Of immense importance to clinicians, Section III focuses on the effect of antihypertensive drug therapy on the circadian variation of blood pressure, heart rate, and myocardial ischemia. This book provides a unique and medically-sound approach to the management of patients with hypertension and vascular disease.

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Editorial Reviews

Doody's Review Service
Reviewer: John F. Moran, MD (Loyola University Stritch School of Medicine)
Description: This text is about blood pressure measurement techniques, circadian variation, and ambulatory blood pressure monitoring written by 21 authors. It is divided into three sections on techniques, circadian variation, and ambulatory blood pressure monitoring.
Purpose: The purpose is to review approximately 15 years of data on ambulatory blood pressure monitoring and its usefulness. There is a big section on circadian rhythm, which is included in this text. This material is not generally covered in other books on hypertension.
Audience: This book is readable and intended for any practitioner who deals with hypertensive patients. The use of ambulatory blood pressure monitoring is increasingly important because of "white coat hypertension," as well as antihypertensive drug selection. The authors presented a credible text.
Features: The first part of the book has to do with the techniques for out of office blood pressure monitoring, the importance of daytime activities, night time measurements, caffeine, talking, blood pressure measurements taken in the home vs. the clinic, are all reviewed. There are also sections on the effect of ambulatory blood pressure monitoring related to the patient's posture, his mood, his work. There are also important variations with blood pressure taken in the season of the year, as well as gender. There is an interesting section on the history of ambulatory blood pressure monitoring, which has been around for perhaps 30 years, but has only recently become somewhat more widely used. There is an excellent review on circadian rhythm, which goes beyond circadian rhythm into ultraradian and infraradian rhythms, as well as seasonal rhythms. There is a good review of the circadian rhythm importance with acute myocardial infarction, unstable angina, sudden cardiac death, and cerebral vascular accidents. There is a brief review on blood coagulation related to circadian rhythms, as well as the importance of the sympathetic nervous system, the renin angiotensin aldosterone system, and sodium and potassium concentrations. A short chapter on chronopharmacology shows the importance of drug selection when treating hypertensive patients. Throughout the text there are several references to the hypertensive "dippers" and hypertensive "non-dippers". Finally, new antihypertensive drug development will have to take into consideration ambulatory blood pressure monitoring and circadian rhythms.
Assessment: This is clearly an addition to the literature, which takes a different path than many of the hypertensive text books that are currently available. This text falls short in the management of hypertension, simply because there is not enough data on drug usage for hypertensive patients, which takes into account circadian rhythms. This text is a worthwhile addition to the medical literature.
In these papers, medical doctors, physiologists, pharmacologists, and other researchers and clinicians critically review various aspects of out-of-office evaluation of blood pressure. They address ambulatory pressure, the relationship between whole-day blood pressure and the cardiovascular disease process, and the effects of antihypertensive therapies on blood pressure parameters. They also describe recent advances in the understanding of the circadian pathophysiology of cardiovascular disorders and argue that ambulatory blood pressure values serve as independent predictors of cardiovascular morbidity and mortality. The methodology for out-of-office blood pressure monitoring, it potential in clinical trials and for the treatment of patients, and its usefulness in drug development are also discussed. Annotation c. Book News, Inc., Portland, OR (

4 Stars! from Doody
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Product Details

  • ISBN-13: 9780896038400
  • Publisher: Springer-Verlag New York, LLC
  • Publication date: 11/28/2000
  • Series: Contemporary Cardiology Series
  • Edition number: 1
  • Pages: 328
  • Product dimensions: 6.20 (w) x 9.20 (h) x 0.90 (d)

Table of Contents

Pt. I Techniques for Out-of-Office Blood Pressure Monitoring
1 Self-Monitoring of Blood Pressure 3
2 Evaluation of Journals, Diaries, and Indexes of Worksite and Environmental Stress 29
3 Electronic Activity Recording in Cardiovascular Disease 45
4 Ambulatory Monitoring of the Blood Pressure: Devices, Analysis, and Clinical Utility 57
Pt. II Concepts in the Circadian Variation of Cardiovascular Disease
5 Circadian Rhythm and Environmental Determinants of Blood Pressure Regulation in Normal and Hypertensive Conditions 79
6 Circadian Variation of the Blood Pressure in the Population at Large 139
7 Importance of Heart Rate in Determining Cardiovascular Risk 159
8 Sodium, Potassium, the Sympathetic Nervous System, and the Renin-Angiotensin System: Impact on the Circadian Variability in Blood Pressure 171
9 Prognostic Value of Ambulatory Blood Pressure Monitoring 191
10 Circadian Rhythm of Myocardial Infarction and Sudden Cardiac Death 219
11 Seasonal, Weekly, and Circadian Variability of Ischemic and Hemorrhagic Stroke 243
Pt. III Twenty-Four-Hour Blood Pressure Monitoring and Therapy
12 Cardiovascular Chronobiology and Chronopharmacology: Importance of Timing of Dosing 255
13 Advances in Ambulatory Blood Pressure Monitoring for the Evaluation of Antihypertensive Therapy in Research and Practice 273
Index 299
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