Achievements in hypertension: A 25 year overview

Only 25 years ago, the field of hypertension was challenged by retrospective clinical data and epidemiologic information suggesting that an elevated arterial pressure is a major risk factor for enhanced cardiovascular morbidity and mortality. Not only was antihypertensive therapy looked on by many as dangerous and fraught with severe and undesirable side effects, but its validity in reversing the course of disease was not yet demonstrated. This review discusses the dramatic new information amassed over the past 25 years that points to the new physiologic and clinical concepts concerning hypertension. It considers impressive new diagnostic techniques and methods designed to identify secondary forms of hypertension and target organ involvement. In summary, it outlines the feasibility of reversing overall (and cardiovascular) morbidity and mortality with an array of antihypertensive agents that provide the therapeutic ability to suppress most pathophysiologic pressor mechanisms of hypertensive disease. The lesson is clear: hypertension provides the greatest available challenge to the new era of preventive cardiology in the 21st century.