In cardiovascular prevention, there is classically a small number of cardiovascular risk factors to treat, such as hypertension, diabetes, hyperlipidemia and smoking excess, which are widely detected and treated. Recently, it has been widely recognized that new mechanical factors should be detected and treated and involves specifically pulsatile arterial hemodynamic (PAH) parameters such as: arterial stiffness, pulse pressure, and, to a lesser extent, augmentation index and pulse pressure amplification. The pedagogic aspect of this new CV specialty involves 3 principal parts: a. –Basic concepts and pathophysiological mechanisms of PAHb. –Clinical aspects and end-organ damage in PAHc. – Clinical pharmacology and therapeutics of PAH This book represents the first that spans basic science and clinical management of this new CV subspecialty. Much has been learned regarding the management of these patients in recent years and this book presents extensive data on the techniques needed to maximize outcomes.
Innehållsförteckning
SECTION I – Basic concepts and pathophysiological mechanisms of PAH.- Principles and definitions of arterial stiffness, wave reflections and pulse pressure amplification.- Large arteries, microcirculation and the mechanism of hypertension.- Direct measurement of local arterial stiffness and pulse pressure.- Determination of systemic and regional arterial stiffness.- Calcifications.- Mechanical stress and the arterial wall.- Pulsatile stress, arterial stiffness and endothelial function.- Endothelial-dependent vascular modulation by pulse perfusion.- Central arterial aging: humans to molecules.- Elastin, calcium and the arterial wall.- Animals models for studies of arterial stiffness.- Renin-angiotensin system, large arteries and microcirculation.- Arterial distensibility and the sympathetic nervous system.- SECTION II – Clinical aspects and end-organ damage in PAH.- Brachial and central pulse pressure, and cardiovascular risk.- Large artery stiffness and cardiovascular risk: Introduction to risk assessment and new strategies.- Therapeutic trials and cardiovascular risk.- Genetic aspects of arterial stiffness and pulse pressure in clinical hypertension.- Heart rate, pulse pressure and arterial stiffness.- The relation of large arterial structure and function to cardiac hypertrophy in hypertension.- Arterial stiffness in hypertension and chronic heart failure.- Arterial stiffness and various cardiovascular diseases.- Arterial function in end-stage renal disease.- Arterial changes in renal transplantation.- Carotid cerebral circulation and arterial stiffness.- Aging process.- Hypertension in women: is it different?.- Arterial stiffness and wave reflections at the different stages of the hypertensive vascular disease.- Diabetes, (lipids) and other cardiovascular risk factors.- Pulsatile hemodynamics and thrombino formation.- Lipids and atherosclerotic disease.- SECTION III – Clinical pharmacology and therapeutics of PAH.- Antihypertensive drug treatment and cardiovascular prevention: an update including the 2003-2004 secondary prevention trials.- Changing concepts on the role of blood pressure reduction in cardiovascular prevention.- Principles of measurement, preventing and treating arterial stiffness.- Nitrates and endothelial function.- De-stiffening strategy, sodium balance and blockade of the renin-angiotensin system.- Aldosterone antagonists, arterial stiffness and wave reflections.- Drugs acting on collagen cross-linking.- Long-term effects of converting enzyme inhibitors, calcium antagonists and -blocking agents on peripheral and central arteries.- Statins and arterial stiffness.- Nonpharmacological treatment of increased arterial stiffness and altered wave reflections.- BP variability.
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