[Pathogenesis and treatment of hypertension]

Many hypotheses have been advocated to explain the pathogenesis of essential hypertension: Guyton's autoregulation theory, the natriuretic hormone theory represented by de Wardner, the sympathetic nervous system theory, and the genetic theory etc. However, none of these theories alone explain the single etiology of hypertension and as stated in Page's Mosaic theory, complicated interaction of many factors has been implicated. We have performed a series of studies to evaluate the interaction between the pressor and depressor systems in relation to salt balances and found in general that hyperfunction of the pressor system and the reduced activity of the depressor systems exist in essential hypertension. Many substances also have been found to be involved in the blood pressure regulation and recently endothelin, a most potent pressor peptide which derives from endothelial cell, was discovered and synthesized by Yanagisawa et al. and its pathophysiological roles are now being extensively investigated. On the other hand, the development of many antihypertensive drugs with different modes of action has enabled us to individualize the treatment of hypertension. Further development of drugs with fewer adverse side effects, whether symptomatic or of abnormality in the clinical laboratory data, and which can maintain or even improve the quality of life is mandatory to pursue life-long treatment of hypertension for successful prevention of the fatal vascular complications.