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Q J Med 2000; 93: 703-705
© 2000 Association of Physicians

Editorial

Step test in hypertension

P.O. Lim and T.M. MacDonald

Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff CF14 4KN

The physiological basis of essential hypertension is a continuing rise in the systemic vascular resistance (SVR) over time, a process which does not appear to be halted by drug treatment that normalizes diastolic blood pressure (BP).1 Since SVR is a major determinant of BP in the absence of left ventricular (LV) systolic dysfunction, BP rises in parallel with the SVR. This can easily be demonstrated with drugs such as phenylnephrine or cyclosporin that increase the SVR. It was previously thought that peripheral vasoconstriction was a ‘protective’ response to an early hyperkinetic circulation. However, this hypothesis has largely been discounted.2 Hypertension is thus the response to an increased SVR, the aetiology of which is still unclear. The increased pressure generated within the left ventricle to maintain a high level of systemic arterial BP has an inherent tendency to cause . . . [Full Text of this Article]

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