XVth World Congress of Phar macdogy:Metting Abstracts

Supplement 1: P 1-489


The Phar macology of Hypertension-New Challenges
Michael J.Mulvany, Department of Pharmacology, University of Aarhus, University Park 1240,8000 Aarhus C.,Denmark
The introduction in 1957 of thiazides for the treatment of essential hypertension(EH) changed a life-threatening disease into one which could be controlled. Modern therapies using e.g. angiotensin receptor antagonists are effective and almost without side-effects. Significant questions, however, remain. First, although treatment reduces risk, the risk is not normalized. Second,the cause of EH remains unknown. Third, EH is still a disease requiring life-long treatment. The hallmark of EH is, apart from increased blood pressure, the structural change of the resistance vasculature, with reduced lumenand increased wall:lumen ratio. This structural change is the earliest type of target-organ damage, and recent evidence shows structural change in the resistance vasculature is a strong risk factor for later cardiovascular events. Treatment should thus seek not only to reduce blood pressure, but also tonormalize vascular structure. We and others have shown that this requires vasodilator treatment, and recent trials show reduced risk with such treatment compared to traditional EH therapy(beta-blockers and diuretics). Normalization of vascular structure is one of the new challenges for treatment of EH.
Keywords: antihypertensive therapy, vasodilators, vascular structure, cardiovascular risk
Acknowledgements:The author is supported by the Danish Medical Research Council and the Danish Heart Foundation.

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