Pathogenesis of Hypertension

Academic Article

Abstract

  • The complexity of pathophysiologic mechanisms that lead to blood pressure elevation is such that selective, mechanistically based antihypertensive treatment is rarely possible in any hypertensive patient. Hypertension is highly prevalent among middle-aged and elderly persons in our population (117), and the success rate in controlling blood pressure in these individuals is poor (117, 118). For example, in the ALLHAT trial, 34% of participants did not achieve the goal blood pressure of less than 140/90 mm Hg despite use of combination therapy, including a β-blocker (104). Current treatment guidelines generally recommend a generic approach to treating hypertension, with little emphasis on selecting therapy on the basis of the underlying pathophysiology of the elevated blood pressure (100-102). With increased recognition of specific causes, it may be possible to develop therapies selective for distinct pathophysiologic mechanisms with fewer adverse effects, resulting in more effective blood pressure reduction. Use of powerful new techniques of genetics, genomics, and proteomics, integrated with systems physiology and population studies, will make possible more selective and effective approaches to treating and even preventing hypertension in the coming decades.
  • Authors

    Published In

  • ACP journal club  Journal
  • Digital Object Identifier (doi)

    Author List

  • Oparil S; Zaman MA; Calhoun DA
  • Start Page

  • 761
  • End Page

  • 776
  • Volume

  • 139
  • Issue

  • 9