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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.
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.
Main headings: I. Basic concepts of pulsatile arterial
hemodynamics. - II. Pathophysiological mechanisms. - III. Arterial
stiffness, wave reflections, cardiovascular risk and end-organ
damage. - IV. Clinical aspects of arterial stiffness and wave
reflections. - V. Therapeutic aspects of arterial stiffness and
wave reflections.
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