A modern plan for treating hypertension.
Essential hypertension is a heterogeneous spectrum of pathophysiologic disturbances, not a single entity. Identification and characterization of two different vasoconstrictor mechanisms--one renin-mediated, the other sodium-volume mediated--has made it possible not only to apply antihypertensive drug therapy on a more rational basis but to screen out a significant number of cases of curable (high-renin) renovascular disease as well as many cases of curable (low-renin) primary aldosteronism. An array of five major drug types makes long-term monotherapy for essential hypertension an achievable goal. Converting enzyme inhibitors and beta-blockers counteract the renin-mediated vasoconstriction; diuretics, calcium-channel antagonists, and alpha-blockers oppose the low-renin sodium-volume-mediated form of vasoconstriction. This information brings us closer to the primary goal of modern therapy: to give each patient the fewest drugs in the smallest amounts and with the least frequency possible for the often lifetime commitment that antihypertensive therapy involves.
Laragh
J H
JH
Cardiovascular Center, New York Hospital-Cornell Medical Center, NY 10021.
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002216:Captopril; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D012083:Renin / Q000097:blood; D012964:Sodium / Q000652:urine
D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D002216:Captopril; D012964:Sodium; D012083:Renin