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A modern plan for treating hypertension.

J H Laragh1

  • 1Cardiovascular Center, New York Hospital-Cornell Medical Center, NY 10021.

Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association
|January 1, 1988
PubMed
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Essential hypertension is not a single disease but has two main causes: renin-mediated and sodium-volume-mediated vasoconstriction. Understanding these mechanisms allows for targeted drug therapies, improving treatment for hypertension.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Essential hypertension presents as a complex spectrum of pathophysiologic disturbances.
  • Distinguishing between different vasoconstrictor mechanisms is crucial for effective treatment.

Purpose of the Study:

  • To characterize the two primary vasoconstrictor mechanisms in essential hypertension: renin-mediated and sodium-volume-mediated.
  • To establish a rational basis for antihypertensive drug therapy and identify curable conditions.

Main Methods:

  • Identification and characterization of renin-mediated and sodium-volume-mediated vasoconstriction.
  • Classification of antihypertensive drugs based on their mechanism of action.

Main Results:

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  • Two distinct vasoconstrictor mechanisms identified: one renin-mediated, the other sodium-volume mediated.
  • Five major drug classes identified for monotherapy: converting enzyme inhibitors, beta-blockers, diuretics, calcium-channel antagonists, and alpha-blockers.
  • Therapeutic strategies enable screening for curable renovascular disease and primary aldosteronism.

    • Conclusions:

    • Understanding the underlying mechanisms of essential hypertension allows for more targeted and rational drug selection.
    • Long-term monotherapy for essential hypertension is achievable with appropriate drug choices.
    • The goal of therapy is to minimize drug количество, dosage, and frequency for lifelong management.