Essential hypertension as an endocrine disease.

Several lines of evidence strongly suggest that the majority of patients with essential hypertension have an endocrine basis for their elevated blood pressure. Abnormalities in vascular tone, circulating hormone levels, and the responsiveness of target tissues to these hormones all contribute to the pathogenesis of the increased blood pressure. The actual frequency of each of these subsets of patients is unknown, but it is likely to be substantial. Intriguingly, most of these abnormalities are not associated with hormonal overproduction per se but, rather, a change in the response of target tissues to specific hormones, with compensatory mechanisms actually responsible for the increased blood pressure. There is evidence that each of these endocrine abnormalities may be inherited, so there is a high likelihood that a genetic marker can be found to identify each subgroup. Already there is the intriguing possibility that if subgroups of patients can be identified easily, specific therapy will be possible.