Hypertension and Stroke: Pathophysiology and Management (Clinical Hypertension and Vascular Diseases)

This timely volume addresses the intimate pathophysiologic relationship between hypertension and cardiovascular disease. Hypertension is one of the most important global public health challenges, and its relationship to stroke and other catastrophic cerebrovascular diseases is an area of growing understanding. In this outstanding book, the editors and authors clearly and concisely synthesize our developing knowledge and place epidemiologic and physiologic information into a practical clinical context. Comprehensive chapters present the evidence supporting strategies for stroke prevention and care, including blood pressure lowering therapies, anti-coagulation, and management of other cerebrovascular risk factors. In addition to prescriptive measures for first stroke prevention, the book illuminates current regimens for care immediately after acute stroke and for the prevention of recurrent stroke. A unique section is dedicated to the exploration of the interaction between elevated blood pressure and brain function and cognition. The concluding chapter provides a resource towards optimizing the organization of stroke care. Hypertension and Stroke is of great utility for specialists in neurology and cardiovascular medicine and a valuable practical resource for all physicians caring for older adults and hypertensive patients. Front Matter....Pages i-xiv Front Matter....Pages 1-1 Blood Pressure: Definition, Diagnosis, and Management....Pages 3-19 The Link Between Hypertension and Stroke: Summary of Observational Epidemiological Studies....Pages 21-39 Blood Pressure Control and Primary Prevention of Stroke: Summary of Clinical Trial Data....Pages 41-59 Front Matter....Pages 61-61 Mechanisms Underlying Essential Hypertension: Neurogenic and Nonneurogenic Contributors....Pages 63-76 Pathophysiology and Mechanisms Whereby Hypertension May Cause Stroke....Pages 77-94 Front Matter....Pages 95-95 Cardiovascular Risk Assessment and Summary of Guidelines for the Management of Hypertension....Pages 97-113 Acute Blood Pressure Management After Ischemic Stroke....Pages 115-126 Hypertensive Encephalopathy and Acute Blood Pressure Management After Hemorrhagic Stroke....Pages 127-141 Recurrent Stroke Prevention I: Diuretic and Angiotensin-Converting Enzyme Inhibitors (ACEIs) – The PROGRESS Trial....Pages 143-157 Recurrent Stroke Prevention II: Angiotensin Receptor Blockers—The LIFE, MOSES, PRoFESS, and Other Trials....Pages 159-171 A Practical Guide to Recurrent Stroke Prevention....Pages 173-192 Front Matter....Pages 193-193 Vascular Cognitive Impairment and Alzheimer Disease: Are These Disorders Linked to Hypertension and Other Cardiovascular Risk Factors?....Pages 195-210 Cerebral Small Vessel Disease, Hypertension, and Cognitive Function....Pages 211-224 Cerebral Microbleeds, Small-Vessel Disease of the Brain, Hypertension, and Cognition....Pages 225-235 Imaging Effects of Hypertension on the Brain: A Focus on New Imaging Modalities and Options....Pages 237-255 Front Matter....Pages 257-257 The Joint Commission’s Initiatives to Improve Stroke Care and What It Means for Acute Stroke Care and Prevention....Pages 259-268 Back Matter....Pages 269-279 Stroke is the third leading cause of death in the US and a leading cause of disability among adults. Stroke is not an accident but occurs in relation to a number of risk factors or antecedents. Hypertension is the most important modifiable risk factor for stroke, and blood pressure level may play an important role in determining outcome after acute ischemic or hemorrhagic stroke. Hypertension remains poorly controlled in the community at-large, and once stroke occurs clinicians are not certain about proper management of blood pressure during the acute, subacute and chronic periods after stroke. Given the importance placed on hypertension as a risk factor for stroke and new data which is now available from clinical trials regarding management of hypertension for stroke prevention and after stroke, a compendium is needed to concisely summarize the available data on hypertension and stroke and direct clinicians about proper treatment of blood pressure. This text will address the epidemiology, mechanism, and pathophysiology of hypertension and blood pressure in relation to stroke and other brain sequelae of abnormal blood pressure, results of clinical trials demonstrating best suggested practice modalities to manage blood pressure and hypertension, and provide practical management tips for controlling blood pressure and hypertension. The book will be a valuable asset to medical students, resident physicians, practicing physicians, and other health care professionals who treat stroke patients or deal with persons at high-risk for stroke.