Cardiovascular disease and hypertension

The cellular and molecular mechanisms whereby hypertension causes vascular and cardiac disease are beginning to be understood. Angiotensin II, perhaps because so many probes to explore its action are available, is emerging as a central pathogenetic factor in the development of both vascular and cardiac hypertrophy. It is clear that this peptide has direct growth effects on vascular smooth muscle cells and cardiocytes as well as indirect effects by stimulating the synthesis of growth factors or potentiating their effects. However, the details of its action need clarification. Abnormalities in endothelium-derived relaxing factor regulation are a new pathogenetic mechanism of hypertension and are also likely to be intimately involved in the development of hypertensive cardiovascular disease. In the clinical arena, converting enzyme inhibitors are emerging as the best antihypertensive agents, and new therapeutic trials add further support to the suspicion that, when in doubt, it is better to treat.