Reversal of target-organ involvement in systemic hypertension: a pharmacologic experience.

Systemic hypertension is a disease manifested by a persistently elevated arterial pressure produced by an increased total peripheral resistance, which is more or less uniformly distributed throughout the component circulations. Unless pressure is reduced and maintained at controlled levels, it will be associated with impaired function of the primary target organs of the disease: brain, heart, kidneys and blood vessels. The effects of an elevated arterial pressure on heart and kidneys and the effects of antihypertensive therapy on target-organ involvement will be discussed. Cardiac involvement primarily relates to left ventricular hypertrophy and its regression with treatment, and in the kidney to altered intrarenal hemodynamics and effects of treatment. The role of calcium antagonists, primarily diltiazem, is discussed with reference to its hemodynamic effects on reducing total peripheral resistance and arterial pressure associated with regression of ventricular hypertrophy and maintenance of renal blood flow without inordinately increasing glomerular hydrostatic pressure. Studies suggest a beneficial role of diltiazem in the treatment of essential hypertension.