The effects of treatment on target organ damage in hypertensive disease.

The mortality rate from malignant hypertension has been dramatically reduced and the morbidity and mortality attributable to essential hypertension have been significantly decreased since the introduction of potent antihypertensive drugs (Mroczek et al., 1969; Gudbrandsson et al., 1970; Veterans Administration Cooperative Group, 1970). While the efficacy of antihypertensive treatment now seems quite well established, it has become clear that not all of the target-organ effects ofhypertensive disease are equally well prevented or reversed by therapy. This review will attempt to examine some of the responses of target organs to treatment in patients with hypertensive disease. The major clinical features of malignant or accelerated hypertension hypertensive encephalopthy, cerebral haemorrhage, and renal failure can best be viewed as manifestation of a failure of autoregulation or 'autoregulatory breakthrough', i.e., the endorgan damage is a consequence of increased hydrostatic pressure in the distal arteriolar and capillary beds.