title: Non-modulating essential hypertension: a subset particularly responsive to converting enzyme inhibitors.
abstract: The goals of antihypertensive therapy are to normalize arterial pressure and to minimize pharmacological adverse effects. Recent data indicate that in general the first goal has been achieved but the second has not, resulting in a substantial non-compliance rate. There is increasing evidence, therefore, that the next major step forward in treating hypertensive patients is to link specific forms of therapy to subsets of the hypertensive population. The present article illustrates this point by describing the characteristics and therapeutic implications of a subset of essential hypertensives termed non-modulators and the therapeutic implications which arise. These individuals have a defect in the way that sodium intake modifies adrenal and renal vascular responses to angiotensin II, resulting in an abnormality in sodium handling. Angiotensin converting enzyme (ACE) inhibitors partially, if not completely, correct this underlying defect and thereby reduce blood pressure by restoring the renal vascular responsiveness to normal. Because of the specificity of ACE inhibitors in treating non-modulators, it is to be expected that they would produce fewer long term side effects, resulting in a better quality of life for these patients than if their blood pressures were treated non-specifically.
mesh_terms: D000311:Adrenal Glands / Q000503:physiopathology; D000450:Aldosterone / Q000097:blood; D000804:Angiotensin II / Q000494:pharmacology; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D009318:Natriuresis / Q000187:drug effects; D012079:Renal Circulation / Q000187:drug effects; D012084:Renin-Angiotensin System / Q000187:drug effects; D012965:Sodium Chloride / Q000494:pharmacology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D000804:Angiotensin II; D012965:Sodium Chloride; D000450:Aldosterone