Hypertension: Basics Concepts and the Evolving Role of Novel Treatments

Hypertension, a major cardiovascular risk factor, is the primarily cause of mortality worldwide. A large body of evidence indicates that patients with essential hypertension, and even more those with complicated hypertension, are characterized by endothelial dysfunction due to impaired nitric oxide (NO) availability secondary to oxidative stress production. Therefore, a dysfunctioning endothelium is an early marker in the development of cardiovascular events. This observation suggest that treatment strategies that improve endothelial function would exert beneficial effects in hypertensive subjects, and may also help to prevent the development of hypertension and its cardiovascular complications. Part I of the present review describes the etiology of hypertension as well as the role of NO in the physio-pathology of the endothelium whereas in Part II, we are reporting novel treatments e.g. beta-blockers, ACE inhibitors, calcium channel antagonists, NO therapies, selective inhibitors of PDE Type 5, statins and regular aerobic physical exercise to the event to improve or restore endothelial function. In the near future, large scale clinical trials are required to demonstrate that treatment of endothelial dysfunction can lead to better prognosis in patients with essential hypertension.