Fig. 1. Trends in the awareness, treatment, and control of high blood pressure in the United States. (Data from http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm .)

Fig. 2. Modified Venn diagram depicting the convergence of major schools of thought regarding the pathogenesis of hypertension.

Fig. 3. A sample 24-hour ambulatory blood pressure (BP) monitoring record. The shaded areas represent normal systolic BP and diastolic BP, respectively. The nocturnal decrease in BP (or dip) is seen in healthy patients. Individuals who do not exhibit a nocturnal dip have an increased incidence of cardiovascular events. Loss of the nocturnal dip is increasingly common in patients with certain conditions, such as chronic kidney disease and secondary causes of hypertension. An increase in BP (the morning surge) occurs during the transition from sleep to wakefulness. The incidence of acute myocardial infarction is higher in the early morning hours (during the surge) than throughout the daytime hours. The upper and lower readings (dashed lines) reflect variability in BP that virtually all patients exhibit. Labile hypertension is associated with marked variability in BP. The mean 24-hour ambulatory BP measurement is a better predictor of cardiovascular events than the routine office measurement, perhaps because it reflects the daily BP burden.

Fig. 4. Effects of age on systolic blood pressure and diastolic blood pressure.

Fig. 5. The relative risk of a cardiovascular event versus systolic or diastolic blood pressure. (Data from Izzo JL Jr, Levy D, Black HR. Clinical Advisory Statement. Importance of systolic blood pressure in older Americans. Hypertension 2000;35:1021–4.).

Fig. 6. Effects of vessel wall compliance on systolic and diastolic blood pressure.

Fig. 7. Evaluation of hypertension.

Fig. 8. Fundoscopic examination result revealing the classic changes of moderate hypertensive retinopathy. Several cotton wool spots (black arrows) are noted. Dot and blot hemorrhages also are easily seen (asterisks). Cotton wool spots reflect ischemic atrophy because of microvascular injury, whereas hemorrhages are secondary to bleeding from injured blood vessels. There is also evidence of widening or accentuation of the central light reflex (blurring) known as copper wiring (white arrows).

Fig. 9. Site of action of the antihypertensive agents.

Fig. 10. The central sympatholytics exert their effect in vasomotor centers of the brainstem. The central synapse (exploded image) depicts the catecholamine receptors involved in sympathetic neurotransmission.

Fig. 11. Model of an L-type (ie, long-lasting) voltage-dependent calcium channel.

Fig. 12. Model depicting the site of action of drugs that block various steps in the renin–angiotensin cascade. (ARB indicates angiotensin-receptor blocker.)

Fig. 13. Algorithmic approach to the treatment of high blood pressure according to category. Abbreviation: BP indicates blood pressure.

Fig. 14. Classic experimental model of renovascular hypertension developed by Goldblatt, et al. in the 1930s (ie, Goldblatt hypertension): A. one-kidney–one-clip model; B. two-kidney–one-clip model. (© Goldblatt H, et al., 1934. Originally published in Journal of Experimental Medicine . 59:347–79.)

Fig. 15. Approach to the diagnosis and management of the patient with suspected primary hyperaldosteronism.

Fig. 16. Approach to the diagnosis and management of the patient with suspected pheochromocytoma.

Fig. 17. Cerebral autoregulation in patients with normal blood pressure (BP) versus patients with sustained hypertension. Sustained hypertension shifts the autoregulatory curve to the right. Therefore, BP should be decreased cautiously in all patients with hypertension, especially those with cerebrovascular disease. The autoregulatory curve can shift to the left (near baseline) with gradual control of BP over a period of several months. (Ruland S, Aiyagari V. Cerebral autoregulation and blood pressure lowering [editorial]. Hypertension 2007;49:977–8.)

Table 1. Pharmacokinetics of Commonly Prescribed Diuretic Agents

Table 2. Coexisting Clinical Conditions That Influence Antihypertensive Drug Choice

Table 3. Drugs for the Treatment of Hypertensive Emergency

Table 4. Classification of Hypertensive Disorders in Pregnancy

Table 5. Summary of Society Guidelines for Treatment of Hypertension in Pregnancy

Table 6. Treatment of Chronic Hypertension in Pregnancy

Table 7. Risk Classification for Contraceptive Use in Patients With Isolated Hypertension