Beyond the sphygmomanometric numbers: Hypertension as a syndrome

Blood pressure is a critical element of hypertension, but evidence shows th at many other interrelated risk factors-such as hypercholesterolemia, left ventricular hypertrophy, insulin resistance, and vascular dysfunction-contr ibute to form a complex syndrome of hypertension. Studies have demonstrated that these other risk factors often precede the onset of elevated blood pr essure (BP). Significantly, this has been shown in the normotensive offspri ng of hypertensive parents. One factor that the elements of the hypertensio n syndrome have in common is endothelial dysfunction. An upset in the norma l balance of angiotensin II and nitric oxide in the endothelial cell is ass ociated with manifestation of the hypertension syndrome-associated risk fac tors. Recognition of this fact can and should be constructively incorporate d into clinical practice in three ways: earlier identification of patients with the hypertension syndrome, earlier treatment to prevent disease onset/ progression, and the use of angiotensin converting enzyme inhibitors to cor rect the critical imbalance in the endothelial cell. (C) 2001 American Jour nal of Hypertension, Ltd.