New contributions to clinical hypertension from molecular biology

Molecular genetics is making enormous contributions to the understanding of complex biologic problems. Essential hypertension is a major health problem worldwide and it is a model of complex disease in which several genes must be affected simultaneously and environmental factors play an important role in the expression of the disease. Despite great progress in our understanding of the pathophysiology of hypertension and the development of an array of antihypertensive agents aimed at interfering with the major systems that control blood pressure, the main genetic determinants of hypertension remain elusive. The development of techniques and strategies for studying the structure and function of isolated genes or for studying genes on a genomewide basis may soon change this picture. The success of this approach is illustrated by the identification of the underlying molecular mechanisms responsible for rare monogenic forms of hypertension. Precise understanding of the molecular mechanisms involved with essential hypertension will allow unique opportunities for preclinical interventions and development of more rational and efficient forms of therapy.