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5.5.5 The brain in hypertension... .. ... ... .. ... .. ... ... .. ... ..25 . . . 8.4 White-coat hypertension. .. ... .. ... ... .. ... .. ... ... .. ... .. ... .56
5.6 Hypertension-mediated organ damage regression and . . . 8.5 Masked hypertension. . ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .57
cardiovascular risk reduction with antihypertensive treatment . . . . . .25 . . . 8.6 Masked uncontrolledhypertension . ... .. ... .. ... ... .. ... .. ... .57
5.7 When to refer a patient with hypertension for . . . 8.7 Hypertension in younger adults (age <50 years) . . . . . . . . . . . . . . . .57
hospital-based care . . . ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..26 . . . 8.7.1 Isolated systolic hypertension in the young. . . . . . . . . . . . . . .58
6 Genetics and hypertension.. ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..27 . . . 8.8 Hypertension in older patients (age >_65 years) ... ... .. ... .. ... .58
7 Treatment of hypertension . ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..28 . . . 8.9 Women, pregnancy, oral contraception, and
7.1 Beneficial effects of blood pressure-lowering therapy . . . hormone-replacement therapy. ... .. ... ... .. ... .. ... ... .. ... .. ... .59
in hypertension.. ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..28 . . . 8.9.1 Hypertension and pregnancy. ... .. ... .. ... ... .. ... .. ... .59
7.2. When to initiate antihypertensive treatment . . . . . . . . . . . . . . . . . . .28 . . . 8.9.2 Oral contraceptive pills and hypertension. . . . . . . . . . . . . . . .61
7.2.1 Recommendations in previous guidelines . . . . . . . . . . . . . . . .28 . . . 8.9.3 Hormone-replacement therapy and hypertension . . . . . . .61
7.2.2 Drug treatment for patients with grade 1 . . . 8.10 Hypertension in different ethnic groups . ... .. ... ... .. ... .. ... .61
hypertension at low–moderate cardiovascular risk . . . . . . . . . . . .28 . . . 8.11 Hypertension in diabetes mellitus.. ... .. ... .. ... ... .. ... .. ... .62
7.2.3 Initiation of blood pressure-lowering drug . . . 8.12 Hypertension and chronic kidney disease . . . . . . . . . . . . . . . . . . . . .63
treatment in older people with grade 1 hypertension. . . . . . . . . .29 . . . . 8.13 Hypertension and chronic obstructive pulmonary disease. . . . . .64
7.2.4 Initiation of blood pressure-lowering drug . . . 8.14 Hypertension andheart disease. ... ... .. ... .. ... ... .. ... .. ... .64
treatment in patients with high–normal blood pressure. . . . . . . .29 . . . 8.14.1 Coronary artery disease . ... ... .. ... .. ... ... .. ... .. ... .64
7.2.5 Should blood pressure-lowering drug treatment be . . . 8.14.2 Left ventricular hypertrophy and heart failure. . . . . . . . . . .65
initiated on the basis of blood pressure values or the level . . . 8.15 Cerebrovascular disease and cognition.. ... .. ... ... .. ... .. ... .66
of total cardiovascular risk?.. .. ... .. ... ... .. ... .. ... ... .. ... ..30 . . . 8.15.1 Acute intracerebral haemorrhage ... .. ... ... .. ... .. ... .66
7.2.6 Initiation of blood pressure-lowering drug treatment. . . . .30 . . . 8.15.2 Acute ischaemic stroke .. ... ... .. ... .. ... ... .. ... .. ... .66
7.3 Blood pressure treatment targets .. .. ... ... .. ... .. ... ... .. ... ..32 . . . 8.15.3 Previous stroke or transient ischaemic attack . . . . . . . . . . .66
7.3.1 New evidence on systolic blood pressure and . . . 8.15.4 Cognitive dysfunction and dementia. .. ... ... .. ... .. ... .67
diastolic blood pressure treatment targets .. ... .. ... ... .. ... ..32 . . . 8.16 Hypertension, atrial fibrillation, and other arrhythmias ... .. ... .67
7.3.2 Blood pressure targets in specific subgroups of . . . 8.16.1 Oral anticoagulants and hypertension . . . . . . . . . . . . . . . . . .68
hypertensive patients . ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..32 . . . 8.17 Hypertension andvascular disease. ... .. ... .. ... ... .. ... .. ... .68
7.4 Treatment of hypertension ... .. ... .. ... ... .. ... .. ... ... .. ... ..34 . . . 8.17.1 Carotid atherosclerosis.. ... ... .. ... .. ... ... .. ... .. ... .68
7.4.1 Lifestyle changes. ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..34 . . . 8.17.2 Arteriosclerosis and increased arterial stiffness . . . . . . . . .68
7.4.2 Dietary sodium restriction . . . . ... ... .. ... .. ... ... .. ... ..34 . . . 8.17.3 Lower extremity arterial disease . ... .. ... ... .. ... .. ... .69
7.4.3 Moderation of alcohol consumption. . . . . . . . . . . . . . . . . . . . .35 . . . 8.18 Hypertension in valvular disease and aortopathy. . . . . . . . . . . . . . .69
7.4.4 Other dietarychanges . . . ... .. ... ... .. ... .. ... ... .. ... ..35 . . . 8.18.1 Coarctation of the aorta. ... ... .. ... .. ... ... .. ... .. ... .69
7.4.5 Weight reduction .. ... .. ... .. ... ... .. ... .. ... ... .. ... ..35 . . . 8.18.2 Prevention of aortic dilation and dissection in
7.4.6 Regular physical activity .. ... .. ... ... .. ... .. ... ... .. ... ..36 . . . high-risk subjects . ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .69
7.4.7 Smoking cessation .. ... .. ... .. ... ... .. ... .. ... ... .. ... ..36 . . . 8.18.3 Hypertension bicuspid aortic valve-related
7.5. Pharmacological therapy for hypertension . .. ... .. ... ... .. ... ..36 . . . aortopathy .. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .69
7.5.1 Drugs for the treatment of hypertension . . . . . . . . . . . . . . . .36 . . . 8.19 Hypertension andsexual dysfunction . . . ... .. ... ... .. ... .. ... .69
7.5.2 Hypertension drug treatment strategy. ... .. ... ... .. ... ..39 . . . . 8.20 Hypertension andcancer therapy.. ... .. ... .. ... ... .. ... .. ... .70
7.5.3 The drug treatment algorithm for hypertension . . . . . . . . . .43 . . 8.21 Perioperative management of hypertension . . . . . . . . . . . . . . . . . . .70
7.6 Device-basedhypertension treatment .. ... .. ... .. ... ... .. ... ..47 . . . . 9 Managing concomitant cardiovascular disease risk. . . . . . . . . . . . . . . . . . .71
7.6.1 Carotid baroreceptor stimulation . . . 9.1 Statins and lipid-lowering drugs .. ... ... .. ... .. ... ... .. ... .. ... .71
(pacemaker andstent) ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..47 . . . 9.2 Antiplatelet therapy and anticoagulant therapy. . . . . . . . . . . . . . . . . .71
7.6.2 Renal denervation . . ... .. ... .. ... ... .. ... .. ... ... .. ... ..47 . . . 9.3. Glucose-lowering drugs and blood pressure . . . . . . . . . . . . . . . . . . .72
7.6.3 Creation of an arteriovenous fistula . . . . . . . . . . . . . . . . . . . . .48 . . . 10 Patient follow-up. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .72
7.6.4 Other devices . .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..48 . . . 10.1 Follow-up of hypertensive patients. ... .. ... .. ... ... .. ... .. ... .72
8 Hypertension in specific circumstances . . . ... ... .. ... .. ... ... .. ... ..48 . . . 10.2 Follow-up of subjects with high–normal blood pressure
8.1 Resistant hypertension . ... ... .. ... .. ... ... .. ... .. ... ... .. ... ..48 . . . and white-coat hypertension . .. ... .. ... ... .. ... .. ... ... .. ... .. ... .72
8.1.1 Definition of resistant hypertension . . . . . . . . . . . . . . . . . . . . .48 . . . 10.3 Elevated blood pressure at control visits ... .. ... ... .. ... .. ... .73
8.1.2 Pseudo-resistant hypertension ... ... .. ... .. ... ... .. ... ..49 . . . 10.4 Improvement in blood pressure control in hypertension:
8.1.3 Diagnostic approach to resistant hypertension. . . . . . . . . . .49 . . . drug adherence. .. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .73
8.1.4 Treatment of resistant hypertension. .. ... .. ... ... .. ... ..50 . . . 10.5 Continued search for asymptomatic hypertension-mediated
8.2 Secondary hypertension... ... .. ... .. ... ... .. ... .. ... ... .. ... ..51 . . . organ damage . . . . ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .74
8.2.1 Drugs and other substances that may cause . . . 10.6 Can antihypertensive medications be reduced or stopped?. . . . .74
secondary hypertension. . ... .. ... .. ... ... .. ... .. ... ... .. ... ..51 . . . 11 Gaps in the evidence . . ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .75
8.2.2 Genetic causes of secondary hypertension. . . . . . . . . . . . . . .51 . . . 12 Keymessages . . . . ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .76
8.3 Hypertension urgencies and emergencies .. .. ... .. ... ... .. ... ..54 . . . 13 ‘What to do’ and ‘what not to do’ messages from the Guidelines . . . . .78
8.3.1 Acute management of hypertensive emergencies . . . . . . . .55 . . . 14 Appendix ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .80
8.3.2 Prognosis and follow-up . ... .. ... ... .. ... .. ... ... .. ... ..55 . . 15 References.. ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... ... .. ... .. ... .80
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