What is Arterial Hypertension? Lessons to be Drawn from Fifty Years of Research and Therapy

Overview

Over the past years the understanding of the pathogenesis of hypertension has increased considerably and many new antihypertensive drugs have been introduced. However, only a minority of patients are treated effectively and there is still concern about full potential for reversing coronary heart disease in hypertensive patients. It is necessary to distinguish between the treatment of a hypertensive population selected in prospective studies and a representative individual patient. The heterogeneity of the population, the individual variability of blood pressure and the rigid numerical criteria to define hypertension and normotension are the main sources of errors and false evaluations. In the future, ambulatory blood pressure measurement devices and better designed trials that conform better to clinical practice will be introduced. Moreover, initiation of antihypertensive treatment, choice of drugs and their doses and combinations should not be based on the number of millimetres of mercury but rather on a careful evaluation of the pathogenetic mechanism and risk factors, since hypertension is not an isolated elevation of blood pressure; it rather is a metabolic impairment of tissue function at the cellular level, genetically conditioned and triggered by various endogenous and external factors.

Key words:
arterial hypertension, ambulatory blood pressure, variability of blood pressure, dippers/non-dippers, ultradian rhythms, clinical studies, pharmacotherapy, bosentan, mivazerol.