HYPERTENSION - WHERE HAVE WE GONE WRONG AND HOW CAN WE FIX IT

Hypertension is defined as a disease of elevated systolic and diastoli c blood pressure and consequently the goals of treating hypertension h ave been simply to normalize the blood pressure. However, effective bl ood pressure control has not resulted in the expected decreases in cor onary artery disease. These findings have forced researchers to reexam ine the importance of blood pressure in causing coronary artery diseas e, and to pose the question ''Is there more to hypertension than high blood pressure?'' Although there are probably several reasons for the poor reduction in the incidence of coronary artery disease in hyperten sive patients, one of the most compelling appears to be the realizatio n that hypertension is not simply a disease of numbers, but is a compl ex inherited syndrome of cardiovascular risk factors, all of which con tribute to heart disease in these patients. Included in the hypertensi on syndrome are abnormalities of lipid profile, insulin resistance, ch anges in renal function, endocrine changes, obesity, abnormalities of coagulation factors, left ventricular hypertrophy and diastolic dysfun ction, and abnormalities of vascular structure and compliance. In many patients, high blood pressure is a late manifestation of this disease process and is preceded by some or all of the associated cardiovascul ar risk factors. Perhaps where we have gone wrong in the management of hypertension is in the belief that this is simply a disease of number s. To improve our management, we need to find methods to diagnose thes e patients early in the course of this disease process, and to treat i t as a syndrome rather than as a number. Am J Hypertens 1998; 11:150S- 157S (C) 1998 American Journal of Hypertension, Ltd.