Cardiovascular Pathophysiology of Essential Hypertension

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Abstract
To initiate antihypertensive therapy, the drug of choice in the young patient is a β-adrenergic receptor blocker; in the elderly it is a haemodynamic vasodilator (anti-adrenergic drug, slow channel calcium blocker, or converting enzyme (ACE) inhibitor), and in black or obese patients it remains a thiazide diuretic. Enalapril, a new ACE inhibitor is indicated as a first-step agent in the great majority of hypertensive patients in whom the elevated arterial pressure should be reduced by a decrease in total peripheral resistance, without compromising systemic or regional blood flow. In contrast to other antihypertensive agents, enalapril will lower preload and aft er load to the left ventricle while improving systemic and regional flow in elderly patients with latent or manifest congestive heart failure.