Molecular Reviews in Cardiovascular Medicine
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Hypertension research has never been more active and extensive than at present. The pace ofits progress has greatly ac celerated with the extraordinary advances in molecular biology and genetics. There is a general consensus that the disease is multifactorial, polygenic and, in the term coined by Irvine Page, is truly a mosaic. Most of these factors are now well known and each ofthese when in excess can create well defined and often remediable types ofhypertension: (1) increased renin-angiotensin system activity as in renovascular hypertension, primary reninism and malignant hypertension; (2) ...
Hypertension research has never been more active and extensive than at present. The pace ofits progress has greatly ac celerated with the extraordinary advances in molecular biology and genetics. There is a general consensus that the disease is multifactorial, polygenic and, in the term coined by Irvine Page, is truly a mosaic. Most of these factors are now well known and each ofthese when in excess can create well defined and often remediable types ofhypertension: (1) increased renin-angiotensin system activity as in renovascular hypertension, primary reninism and malignant hypertension; (2) ex cessive aldosterone production in primary aldosteronism; (3) excessive intake oflicorice through its content in glycyrrhizic acid, a substance with mineralocortical activity; (4) excessive production of cortisol and deoxycorticosterone in Cushing's syndrome; (5) excessive catecholamine production in pheochromocytoma; (6) excessive 18-hydroxy-deoxycorticosterone in glucocorticoid-remediable hypertension; and (7) increased proximal resistance to cardiac output in coarctation ofthe aorta and other such conditions. But what we do not know now is how these factors and others, most probably ofgenetic origin, combine or are integrated in primary or essential hypertension, a category which includes more than 90-95% of all hypertensive patients. Essential hypertension, as defined by blood pressure levels above 140mmHg systolic and 90mmHg diastolic, involves about 20-25% ofentire populations.
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