Heterogeneity of Hypertension

Although all forms of hypertension have in common the finding of elevated blood pressure, further examination reveals great heterogeneity. The risk of hypertension is related not only to the level of blood pressure but also to the presence of other risk factors; the prevalence of hypertension is affected by demographic, clinical, and psychologic characteristics; the pathophysiology of hypertension reflects varying participation of salt-sensitivity, the renin-angiotensin system, and other control mechanisms; and treatment responses differ among patients both with regard to the degree of blood pressure lowering by various therapies and the clinical benefit obtained. Knowledge of these heterogeneities at present is useful but only partial. Additional research is needed to improve prediction of hypertension, to enhance stratification of patients by the mechanisms and risk of their hypertension, to refine the matching of specific therapies and treatment goals to the underlying pathophysiology, and to facilitate transfer of evolving information to the clinician.