Clinical Hypertension [antikvár]

Introduction The first two volumes of the Handbook of Hypertension, respectively on Clinical Aspects of Essential Hypertension and Clinical Aspects of Secondary Hypertension, appeared in 1983. It was my privilege to act as editor for both of these inaugural books. Since 1983, twelve further volumes of the series have appeared, and have entered, often in considerable detail, into many aspects of hypertension, such as epidemiology, pathogenesis, pathophysiology, pharmacology, clinical pharmacology, and hypertension in pregnancy, which I regarded as necessary to be included as individual chapters in Volumes 1 and 2. Thus whilst the present volume, Volume 15, is in part a revised and updated account of many clinical aspects of hypertension first dealt with in Volumes 1 and 2 in 1983, it is more sharply focused than those earlier books, and is without the digressions into several aspects on which 1 considered it was necessary to expound nine years ago. Volume 15 is thus much more strictly and exclusively devoted to clinical hypertension. Of the twenty-seven present chapters ten (eleven if the links with diabetes mellitus advanced by some authorities are accepted) are devoted to primary or essential hypertension. It is gratifying, as well as gently disturbing, to reflect how the traditional definition of essential hypertension - 'high blood pressure without evident cause' - has receded in the past decade. While detailed comprehension remains elusive, we now, as I trust the present pages reveal, possess early but distinct insights into both the genetic and environmental influences upon, as well as the pathophysiology of, this very prevalent affliction. There is no doubt of the morbidity and mortality consequent upon primary hypertension, or of our ability to prevent and contain the disease. Even so, as again these pages I hope will clarify, there are distinct, and sometimes worrying, limits to our therapeutic achievements. The remaining sixteen chapters of the present volume are devoted to the richly varied syndromes of secondary hypertension, their diagnosis and treatment. Several of these were not recognized as entities when Volumes 1 and 2 were published in 1983. I do not intend to apologize for considering secondary forms of hypertension at such length, although some explanation is appropriate. First, physicians need to be acquainted with syndromes of secondary hypertension, and to have access to guidance on their investigation and treatment. Many forms of secondary hypertension are readily responsive to therapy, while mistaken or missed diagnosis can be disastrous. I have had colleagues and close personal acquaintances variously suffering from pheochromocytoma, aldosterone-secreting tumor, and severe hypertension due to oral contraceptive therapy; in all these cases the diagnosis was initially overlooked. Several years ago I had referred to me a young man who had performed two years of military service with unrecognized aortic coarctation. Second, while some syndromes of secondary hypertension are rare, others. IX