Clinical Note

A common disease in Western cultures is hypertension (high blood pressure). With hypertension the MAP is elevated 10 or more mm Hg above 100 mm Hg. Unfortunately, the body does not tolerate hypertension well. The high MAP puts an increased workload on the heart, causing it to enlarge dangerously; it also promotes accelerated atherosclerosis of blood vessels. Hypertension is an established risk factor for coronary artery disease, stroke, and renal failure. Although some patients have renal hypertension as described earlier, most (>90%) suffer from essential hypertension. The word essential simply means that the cause is unknown; however, there is a strong hereditary tendency for this disease. The treatment strategies for hypertension illustrate how the basic physiology of blood pressure control can be manipulated. One of the approaches is to limit salt intake and to give the patient a natriuretic drug like furosemide, which causes the excretion of both salt and water, thus reducing blood volume. Another approach has been to give a cardiac depressant, like propra-nolol, which blocks norepinephrine's effect on the heart and reduces cardiac output. Still another approach has been to give a vasodilator like hydralazine to reduce peripheral resistance and unstressed volume. One of the more popular therapies today is to target angiotensin II bioac-tivity using either angiotensin-converting enzyme inhibitors, which block the formation of angio-tensin II, or angiotensin II receptor blockers. All of these approaches have undesirable side effects but have been effective in controlling a deadly disease. It is hoped the defect in blood pressure control in these patients will someday be identified so the disease can be treated at its source.

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