Hypertension: Our Major Challenges

As the tenure of our 8-year editorship of Hypertension nears its end, a number of scientific issues concerning this very complex multifactorial disease burn in my mind. At the outset of our editorial term, we indicated that a sea change was taking place in our scientific information and clinical thinking about the hypertensive diseases. A virtual upheaval was looming in our fundamental thinking about the genetic, molecular biological, biochemical, physiological, and pharmacological aspects dealing with arterial pressure control and the involvement of the various target organs and systems. Indeed, over these 8 years, massive changes have appeared in the explosion of knowledge concerning our field of investigation. Molecular-biological knowledge has burgeoned, and heretofore unenvisioned genetic information is published each month. Clinically oriented information dealing with the pathophysiology of hypertension and its treatment provides hope that not only can cardiac and renal failure be treated effectively but, when treated early enough, may even be prevented. Each of the fundamental areas of scientific endeavor will most assuredly have a tremendous impact on how clinicians will understand the disease mechanisms of their patients with hypertension and how they will employ new modes of treatment.In reflecting about the progress already made in our understanding and treatment of hypertensive diseases, the quantity of new information amassed over the past several decades has been nothing less than monumental and mind-boggling. Much of the gains made in treatment have already been translated into the remarkable reduction of morbidity and mortality using our initially employed antihypertensive agents. Thus, we have witnessed dramatic downturns in the mortality from stroke, coronary heart disease, hypertensive emergencies, and cardiac failure related to the tremendous systolic function imposed on the functionally and structurally adapting left ventricle. These gains reflect the ability of the earlier antihypertensive agents to control arterial pressure and pressure-related …