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New insights into molecular mechanisms of hypertension.

Despite the availability of a plethora of very effective antihypertensive drugs, the treatment of hypertension remains suboptimal and the prevalence of hypertension is increasing [1 ,2 ]. In his recent Shattick Lecture, Chobanian [3 ] referred to this as the ‘hypertension paradox’, in which, in spite of advances in therapy, hypertension continues to be a major public health problem with a growing number of patients having uncontrolled and resistant hypertension. The ‘hypertension paradox’, together with the facts that essential hypertension is now being diagnosed in adolescents and children and that untreated hypertension shortens life expectancy by approximately 5 years, the prediction for health outcomes related to hypertension and cardiovascular disease is daunting. Reasons for this relate, in part, to poor compliance (due to costs, convenience, lifetime treatment and intolerable side effects) and to a lack of understanding of the exact mechanisms underlying the pathogenesis of hypertension [3 ,4].