Hypertension—Primary and Secondary

Abstract

High blood pressure has received abundant clinical and laboratory attention in recent years. Some 6% of whites and 20% of negroes in the United States are affected by arterial hypertension. The number of cases secondary to renal and adrenal lesions has increased, with a corresponding reduction in the number of patients relegated to the category of essential hypertension. The chief causes of secondary hypertension are renal artery stenosis, primary aldosteronism, and, more recently, excess adrenal secretion of 18-hydroxydeoxycorticosterone. Those patients in the latter category are an exciting group, potentially treatable with dexamethasone. The radiological study of patients with hypertension is highly important, with the intravenous urogram remaining the best screening test. Arteriography and adrenal venography are being used with greater frequency. Drug therapy of hypertension has reached a new stage of effectiveness and specificity, and many patients can be successfully managed medically. The chief indications for surgical intervention are renal artery stenosis in good-risk individuals with definite criteria of renal ischemia, pheochromocytoma, and primary aldosteronism. Many of the reconstructive operations considered speculative only 8 years ago are now proving their long-range usefulness and durability.