Treatment of hypertensive disease.

OF THE variety of pathologic conditions involving abnormally high blood pressure, one is of outstanding importance-essential hypertension. According to current views, the principal pathogenetic mechanism responsible for elevation of blood pressure is assumed to be a generalized arteriolar spasm, with a resulting rise of peripheral resistance to the outflow of blood. It has been proved by our investigations, however, that such a concept is far from being universally acceptable. Not infrequently, the elevation of blood pressure is due to a disturbance of coordination between functions of various links of the cardiovascular system. We have ample evidence that an inadequate response of arterioles (insufficient dilatation) to increasing cardiac output, rather than arteriolar spasin, may be the direct cause of blood pressure elevation. In the treatment of patients with hypertensive disease, the use of potent vasodilating drugs proves to be of minor importance, success depending on a judicious combination of various therapeutic measures aimed at the restitution of normal cardiovascular function. Treatment should include a set of procedures, attacking the causative factors of the disease. The course of the process, as well as the patient 's individuality are to be taken into consideration in selecting a suitable combination of therapeutic agents. Thus, it is well known that there may be wide variations in the sensitivity of individual patients to hypotensive agents having central, ganglionic blocking, adrenolytic, or myotropic activities. It would therefore be a