Beyond the sphygmomanometric numbers: hypertension as a syndrome

Blood pressure is a critical element of hypertension, but evidence shows that many other interrelated risk factors—such as hypercholesterolemia, left ventricular hypertrophy, insulin resistance, and vascular dysfunction—contribute to form a complex syndrome of hypertension. Studies have demonstrated that these other risk factors often precede the onset of elevated blood pressure (BP). Significantly, this has been shown in the normotensive offspring of hypertensive parents. One factor that the elements of the hypertension syndrome have in common is endothelial dysfunction. An upset in the normal balance of angiotensin II and nitric oxide in the endothelial cell is associated with manifestation of the hypertension syndrome-associated risk factors. Recognition of this fact can and should be constructively incorporated into clinical practice in three ways: earlier identification of patients with the hypertension syndrome, earlier treatment to prevent disease onset/progression, and the use of angiotensin converting enzyme inhibitors to correct the critical imbalance in the endothelial cell.