Management of hypertension.

To provide maximal protection against the cardiovascular complications that accompany hypertension, the disease must be managed in ways to minimize the total cardiovascular risk burden. These involve five major steps: (1) careful monitoring of the blood pressure in response to appropriate therapy; (2) assessment of concomitant cardiovascular risk factors; (3) institution of life-style modifications needed to control both hypertension and other risk factors; (4) use of antihypertensive drugs, chosen to best manage the individual patient's overall risk burden and provided in a manner that will lower the pressure gently while avoiding adverse reactions; and (5) identifying and reaching the goal of therapy: levels of blood pressure that are neither too high to avoid increased risks for cerebral and renal damage nor too low to avoid increased risks for coronary ischemia. This monograph builds on the 30-year experience of one of the leading clinical investigators in the field to translate the multiple advances made in the management of hypertension into practical guidelines for improved care of the many millions of patients with this disease. Particular emphasis is directed toward certain therapeutic challenges, including the elderly, diabetic patients, and resistant hypertensive patients.