Michael F. O'Rourke – författare

Arterial Stiffness in Hypertension V23

There is a paradox in hypertension: whereas the pathophysiological mechanisms of the disease have been related principally to a constriction of small arteries, most of the complications refer to damage of the large arteries, particularly at the site of the brain, the kidney and the heart. In the past, large arteries were poorly investigated in hypertension mainly in terms of change in blood flow. Recent studies clearly showed that the large arteries are largely involved in the mechanisms of hypertension not only through changes in mean blood flow, but rather through changes in stiffness of the arterial wall. This aspect may be a key-point for the development of hypertensive complications. Subsequently, the goal of treatment may be not only blood pressure reduction but also improvement of structural and functional abnormalities of the large vessels. These therapeutic aspects are analyzed in detail in the present book.

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.​