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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


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).

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) ...

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