(Circulation. 2000;101:329.)
© 2000 American Heart Association, Inc.
Clinical Cardiology: New Frontiers |
Essential Hypertension
Part I: Definition and Etiology
From the Hypertension and Vascular Research Division, Heart and Vascular Institute, Henry Ford Hospital, Detroit, Mich (O.A.C.), and the Division of Cardiovascular Disease, Vascular Biology and Hypertension Program, University of Alabama School of Medicine, Birmingham (S.O.).
Correspondence to Oscar A. Carretero, MD, Hypertension and Vascular Research Division, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202. E-mail ocarret1@hfhs.org
Key Words: hypertension • pathology • diagnosis
Essential hypertension remains a major modifiable risk
factor for cardiovascular disease (CVD) despite
important advances in our understanding of its pathophysiology and the
availability of effective treatment strategies. High blood pressure
(BP) increases the risk of CVD for millions of people worldwide,
and there is evidence that the problem is only getting worse. In the
past decade, age-adjusted rates of stroke incidence have risen, and the
slope of the age-adjusted rate of decline in coronary disease
has leveled off. The incidence of end-stage renal disease and the
prevalence of heart failure have also increased. A major contributor to
these trends is inadequate control of BP in the hypertensive
population. This review of current concepts regarding the definition,
etiology, and treatment of essential hypertension is intended to aid
the clinician in identifying those individuals at high risk who need to
undergo evaluation and treatment, as well as in selecting optimal
treatment strategies for hypertensive patients with comorbid conditions
and/or target organ damage. The part of the review that deals with the
genetic basis of hypertension and the gene/environment interaction that
may lead to elevated BP is still a work in progress. Information gained
from the Human Genome Project and from ongoing studies of the
genetic basis of hypertension both in animal models and human
populations may revolutionize the treatment of hypertension by
replacing current empirical therapy with more effective, targeted
treatments based on the genotype of the patient. Concepts
introduced in this review form the basis for such "pharmacogenomic"
approaches to
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