Cardiovascular Disease: Arterial Hypertension

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Abstract
Every patient with (hypertension) (HT) must be scrutinized for the presence of detectable and treatable causes of elevated blood pressure (BP). Vigorous anti-HT therapy should be instituted in all patients with HT in the malignant phase, in those with cardiac failure, and in those with left ventricular hypertrophy and dyspnea on exertion even if objective signs of cardiac failure are absent. The decreased life expectancy in younger individuals, especially males with left ventricular hypertrophy and high basal pressures, cogently suggests that anti-HT therapy should be begun in these patients even though definitive evidence for its value has not yet been obtained. The clear association of HT and atherosclerosis suggests that attempts at lowering the serum cholesterol, as well as the BP, are wise, although the therapeutic value is unproved. If our understanding of the HT process in man is to advance beyond the speculative state, fruitful investigation of basic mechanisms is in order, notably the mechanism whereby the normal kidney, or normal kidney tissue, acts to maintain normal BP in man and in the experimental animal; the biochemical, physiological, and anatomical response of human arterioles to controlled experimental conditions; and the role of varying types of emotional stress in initiating or aggravating HT.
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