[100 years of hypertension].
At the opportunity of the 100th anniversary of S. Riva-Rocci's publications on the new sphygmomanometer the author presents a review of the main publications which made this method possible and a review of clinical and pathological studies which led to the recognition of essential hypertension (EHT). He also mentions main adopted criteria of hypertension and draws attention to the difficulties associated with a definition and classification of EHT because of the variations in pressure and differences of "normal" values in various populations. From multicentre intervention studies precise and generally valid criteria for individual treatment cannot be derived. As to recent of work on the pathogenesis of EHT the author draws attention to the importance of endothelin and NO (EDRF), which play a part in the genesis of changes in the vascular wall in atheromatosis and also in hypertension. A new discovery is the bond between NO and haemoglobin (S-nitrosohaemoglobin). In addition to proved and located genetic factors also external factors are involved, in particular psychosocial factors, diet, body weight, smoking etc. on which prevention and treatment must be focused. Medicamentous treatment markedly improves the prognosis of hypertension. Antihypertensive drugs from all main groups of drugs are used. Dosage still remains an open question which cannot be resolved completely on the basis of intervention trials. ACE-inhibitors hold an important place--they reduce the blood pressure and also prevent progression of left ventricular hypertrophy. Beta-blockers and diuretics still remain the basis of first line treatment. Among Ca-inhibitor, preparation with long-term action are preferred. Open questions include--apart from dosage--the comparison of the efficacy/side effects ratio of new effective drugs (A I, A II, renin) and older antihypertensive drugs when used on a long-term basis; furthermore the justification to administer vasodilatating drugs as monotherapy and in combinations during long-term treatment with regard to the activation of the sympathetic nerve and risk of hypotension. The author discusses the sympathetic activation to which BP should be reduced and thus also the question of doses reduction and discontinuation of the drug--in particular in old patients. And finally, the role of hypertension as the sole cause of increased mortality (EEHT per se) must be proved. In practice the problems of the detection rate, adherence, information and correct treatment are of major importance.
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Rehaklinik-Rehabilitacní centrum, kardiologická ambulance, Rheinfelden, Svýcarsko.
D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy
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