Physiologic and hemodynamic considerations in blood pressure control while maintaining organ perfusion.
Essential hypertension remains a significant contributor to mortality, despite treatments effective in decreasing blood pressure. A major reason mortality remains high may be that the conventional stepped-care approach does not always reduce blood pressure in a physiologic manner, which may result in metabolic derangements and elicitation of undesirable reflex mechanisms. Use of the stepped-care approach does not take into account fundamental hemodynamic differences associated with a hypertensive patient's age, race and weight. A nonphysiologic approach in the use of antihypertensive agents may be associated with progression of left ventricular hypertrophy, metabolic derangements, arrhythmias, sudden death, and increased atherosclerotic and nephrosclerotic complications. Considerations of the alterations in cardiovascular structure that can occur in light of the activity of the renin-angiotensin system, the sympathetic nervous system and transcellular calcium flux are discussed as to how they affect long-term survival.
Weir
M R
MR
Department of Medicine, University of Maryland Hospital, Baltimore 21201.
Sowers
J R
JR
D000375:Aging / Q000187:drug effects / Q000502:physiology; D044383:Black People; D001794:Blood Pressure / Q000187:drug effects*; D002118:Calcium / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D009765:Obesity / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology; D044465:White People
D002118:Calcium