PRACTICAL MANAGEMENT OF HYPERTENSION

Second Edition

o knoll

BASF Pharma

This publication has been made possible by an educational grant from

Knoll BV, Amsterdam, The Netherlands.

PRACTICAL MANAGEMENT OF HYPERTENSION Second Edition

edited by

Willem H. Birkenhiger Professor of Medicine (Emeritus) Erasmus University, Rotterdam, The Netherlands

KLUWER ACADEMIC PUBLISHERS DORDRECHT/BOSTON/LONDON

Distributors

for the United States and Canada: Kluwer Academic Publishers, PO Box 358, Accord Station, Hingham, MA 02018-0358, USA for all other countries: Kluwer Academic Publishers Group, Distribution Center, PO Box 322, 3300 AH Dordrecht, The Netherlands

Cataloguing in Publication Data is available from the British Ubrary.

ISBN -13: 978-94-010-7237-3 e-ISBN -13: 978-94-009-1647-0 DOl: 10.1007/978-94-009-1647-0

Library of Congress Cataloging-in-Publieation Data

Practical management of hypertension / edited by Willem H. Birkenhiiger. - 2nd cd. p. em. - (Developments in cardiovascular medicine: v. 184)

Includes bibliographical references and index.

1. Hypertension. I. Birkenhiiger, W. H. II. Series [DNLM: 1. Hypertension-therapy. WI DE997VME v.184 1996 / WG 340 P8955 1996)

RC685.H8P73 1996 616.1'32-dc20 DNLMIDLC for Library of Congress

Copyright

© 1996 by Kluwer Academic Publishers

Softcover reprint of the hardcover 2nd edition 1996

First Edition published 1990

96-115 CIP

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers, Kluwer Academic Publishers BV, PO Box 17, 3300 AA Dordrecht, The Netherlands.

Published in the United Kingdom by Kluwer Academic Publishers, PO Box 55, Lancaster, UK.

Kluwer Academic Publishers BV incorporates the publishing programmes of D. Reidel, Martinus Nijhoff, Dr W. Junk and MTP Press.

Contents

List of authors vii

Preface to Second Edition Willem H. Birkenhiiger ix

lA. General principles of blood pressure measurement Eoin O'Brien 1

lB. Conventional blood pressure measurement Eoin O'Brien 13

Ie. Automated blood pressure measurement Eoin O'Brien 23

2. Pathophysiological basis of hypertension Armin Distler and Arya M. Sharma 35

3. Cardiovascular risk associated with hypertension; interactions with other risk indicators Jan Staessen, Victor Petrov and Robert Fagard 59

4. Evaluation of the hypertensive subject Lennart Hansson and Anders Svensson 71

5. Special situations in hypertension (childhood and adolescence; pregnancy; old age) Lawrence J. Beilin 89

6. How to deal with secondary hypertension Frans Boomsma, Frans H.M. Derkx, Arie J. Man in 't Veld, and Anton H. van den Meiracker 109

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PRACfICAL MANAGEMENT OF HYPERTENSION

7. Non-pharmacological intervention Roger Shinton and Gareth Beevers

SA. Drug treatment: efficacy and adverse effects. Specific responses in patient sub-groups and treatment approach

127

Gastone Leonetti and Cesare Cuspidi 141

SB. Antihypertensive drug combinations Willem H. Birkenhager 161

9. Predictability, assessment and improvement of compliance with regard to taking antihypertensive drugs Gaston E. Bauer 167

Appendix: Profiles and dosages of antihypertensive drugs IS3

Index 191

vi

List of first authors

Dr Gaston E. Bauer 115 Shirley Road ROSEVILLE, NSW 2069 Australia

Professor Gareth Beevers Professor of Medicine City Hospital BIRMINGHAM, B18 7QH UK

Professor Lawrence J. Beilin Department of Medicine University of Western Australia GPO Box X 2213 PERTH WA 6001 Australia

Professor Willem H. Birkenhiiger Erasmus University ROTTERDAM The Netherlands

Dr Frans Boomsma Department Internal Medicine I University Hospital Dijkzigt Dr. Molewaterplein 40 3015 GD ROTTERDAM The Netherlands

Vll

Dr Cesare Cuspidi Istituto Scientifico Ospedale San Luca Via Spagnoletto 3 1-20149 MILAN Italy

Dr Frans H.M. Derkx Department of Internal Medicine I Academic Hospital Dijkzigt Dr. Molewaterplein 40 3015 GD ROTTERDAM The Netherlands

Professor Armin Distler Department of Internal Medicine

and Nephrology University Clinic Benjamin Franklin Free University Berlin Hindenburgdamm 30 D-12200 BERLIN Germany

Professor Robert Fagard Department of Cardiovascular

Rehabilitation University Hospital Pellenberg Weligerve1d 1 B-3212 LUBBEEK (Pellenberg) Belgium

PRACfICAL MANAGEMENT OF HYPERTENSION

Professor Lennart Hansson Department of Geriatrics University of Uppsala P.O. Box 609 S-7 5 125 UPPSALA Sweden

Professor Gastone Leonetti Ospedale San Luca Via Spagnoletto 3 1-20149 MILAN Italy

Professor Arie J. Man in 't Veld Department of Internal Medicine I Academic Hospital Dijkzigt Dr. Molewaterplein 40 3015 GD ROTTERDAM The Netherlands

Dr Eoin O'Brien The Blood Pressure Unit Beaumont Hospital DUBLIN 9 Northern Ireland

Dr Victor Petrov Hypertension Unit Department of Internal Medicine

and Cardiology U.Z. Gasthuisberg Herestraat 49 B-3000 LEUVEN Belgium

Professor Arya M. Sharma Department of Internal Medicine

and Nephrology University Clinic Benjamin Franklin Free University Berlin D-12200 BERLIN Germany

Dr Roger Shinton Department of Elderly Medicine Birmingham Heartlands NHS Trust Yardley Green Unit BIRMINGHAM, B9 5PX UK

Dr Jan Staessen Hypertension Unit Department of Internal Medicine

and Cardiology U.Z. Gasthuisberg Herestraat 49 B-3000 LEUVEN Belgium

Dr Anders Svensson Department of Medicine Ostra Hospital University of Goteborg S-416 85 GOTEBORG Sweden

Dr Anton H. van den Meiracker Department of Internal Medicine I Academic Hospital Dijkzigt Dr. Molewaterplein 40 3015 GD ROTTERDAM The Netherlands

viii

Preface to the Second Edition

This compact guide on the practical management of the hypertensive individual first saw light in 1990. The underlying concept was, and still is, to produce an easily accessible 'leaf-through' type of mini-textbook on the hypertensive individual's condition and the many dilemmas that surround diagnosis, surveillance and intention to treat or not treat.

Our primary aim has been to promote a utilitarian train of thought in the decision-making process in practice, whether general or specialistic. In pursuing this policy, we felt, however, that the terms of practical orientation and advice should be matched, in a concise form, to scientific arguments whenever possible. This cannot always be achieved in reality, so that some chapters unavoidably have a more scientifically-oriented flavour than others. For the 'eager reader' in search of more scientific facts, selected references have been provided. One may rightfully wonder whether such a concept would not turn into a hybrid kind of hypertension guide. And, yes, this booklet has become something of a hybrid, a compromise between an ultra­lean and superbly pictorial compendium like the Clinician's Manual on Hypertension (Hansson, 1990) and the ABC of Hypertension (O'Brien et aI., 1995) on the one hand, and full-blown textbooks (e.g. Laragh and Brenner, 1995; Swales, 1995) and even the Handbook of Hypertension Series, Birken­hager and Reid (1983 onwards) on the other. The number of updated pages between these categories varies from 55 to 5838, as indicated in the Reference list below. It has been a reassuring thought that authors, and even editors, who have participated at either end of the spectrum of the above categories have seen fit to contribute to an intermediate volume of some 200 pages. To manoeuver between ad-hoc and 'teleprompting' guidelines, and toilsome late­evening reading, requires a delicate balance of information and presentation, encompassing both 'recipes' and thorough briefing. Who could do this better than hypertension experts who combine clinical experience and acumen with original scientific research? By a stroke of good luck, it was possible to gather together a family of such authors, who were willing to squeeze their expertise into the sober and rigid framework of the book's outline. I wish to compliment all of them on their idealism, as well as their arduous work in bridging the gap between 1990 and 1996, and I truly hope that they

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PRACfICAL MANAGEMENT OF HYPERTENSION

experience some satisfaction in knowing that the formula has had sufficient appeal for a well-known industrial sponsor to join with our Publisher in bringing their work to a wide audience.

lowe a special word of thanks to my loyal friend Professor Eoin O'Brien for his continuous support and advice.

References

Willem Birkenhiiger Rotterdam. December 1995

Hansson L (ed.). Clinician's Manual on Hypertension (International Society of Hypertension). Current Science, London; 1990:SSp.

O'Brien E, Beevers DG, Marshall HJ. ABC of Hypertension, 3rd edn. BMJ Publishing Group, London; 1995:79p.

Rosenthal J (ed.). Arterial Hypertension. Springer, New York; 1982:S29p. Swales JD (ed.). Textbook of Hypertension. Blackwell, Oxford; 1994:1328p. Laragh JR, Brenner BM (eds.). Hypertension, 2nd edn. Raven Press, New York; 1995:3219p. Birkenbiger WH, Reid JL (eds.). Handbook of Hypertension. Elsevier Science, Amsterdam;

1983-2000:5838p (updated)

x