Preface

Hypertension or high blood pressure is widely prevalent and a major risk factor for cardiovascular diseases including coronary heart disease, myocardial infarction and stroke, and frequently causes damage to the arterial blood vessels, the eyes and kidneys. Prolonged hypertension can also lead to enlargement of the heart and may cause heart failure. This disease is usually asymptomatic until the damaging effects of hypertension are observed. Therefore, hypertension is known as the "silent killer." Several survey studies for assessing the burden of hypertension in different societies revealed that many subjects with hypertension were unaware of their disease, many of the aware subjects were not on treatment, and many of the treated patients were not controlled properly, particularly in developing countries. Hypertension afflicts more than one billion population worldwide and is a leading cause of morbidity and mortality. It has been predicted that in year 2025 it will increase by 24% in developed countries and 80% in developing countries. However, the expected increase may be much higher than these projections.

This book is another contribution to the application of new knowledge in the area of hypertension. Authors of this book are from different parts of the world sharing their new knowledge and experience in the direction of deep understanding and more clarification of the disease. They look from different angles to hypertension, providing an invaluable resource not only for clinicians, but also for all medical sciences students and health providers. I hope this book will provide new insight into hypertension disease and greater visibility and access to detection and treatment of vulnerable patients.

> **Prof. Hossein Babaei**  Drug Applied Research Center, School of Pharmacy, Tabriz University of Medical Sciences, Iran

**1** 

*Cuba* 

Jorge Luis León Alvarez *Hospital Hermanos Ameijeiras,* 

**New Therapeutics in Hypertension** 

Cardiovascular diseases are the leading cause of morbility and mortality worldwide. The main risk factor that contributes to the development of these cardiovascular diseases is hypertension. Hypertension increases the risk of injury in the vascular beds of various target organs such as retina, brain, heart and kidneys. Morbility and mortality associated with hypertension is associated mainly with cardiovascular complications. The main goal in the treatment of hypertension is not only controlling blood pressure (BP), but also reducing

The therapeutical management of hypertension has advanced considerably in recent decades, both in terms of its efficacy in available treatments as in its safety and tolerability profiles.(Table.1) Multiple effective antihypertensive drugs exist to carry out a logical choice. It is necessary to take into account the pathogenic alterations of renin secretion, sympathetic tone, renal sodium excretion, changes in cardiac output, peripheral vascular resistance and blood volume, without forgetting the individual considerations in each patient. However, none of the antihypertensive drugs currently available are able to control all cases of hypertension by themselves. For this reason, monotherapy alone is not usually able to lower BP to optimal levels in most patients. The use of combination therapy with antihypertensive drugs has become the norm. (Calhoun et al., 2008). However, the number of people with uncontrolled hypertension has increased, despite the innumerable evidence of the benefit of

At present the new knowledge obtained about the renin angiotensin aldosterone system (RAAS), the role of the endothelium and nitric oxide (NO), and the ion channels in the homeostasis of BP among others, have opened new lines of study. Therapeutical developments have recently emerged that could improve control of BP, either because they are new and alternative therapeutic strategies, such as carotid sinus stimulation devices, renal denervation and vaccination or due to the improved knowledge of existing alternatives.

This review will focus on little used antihypertensive drugs or on the emerging and application of new therapeutic strategies such as vaccination, renal denervation and the

The importance of the RAAS in the pathogenesis of cardiovascular and renal diseases and hypertension among them has encouraged research to achieve blocking it partially or

**1. Introduction**

cardiovascular risk. (Chobanian et al., 2003)

activation of baroreceptors.

**2. Renin inhibitors** 

BP control and the advances in therapy. (Kearney et al., 2005)
