Science,medicine, and the future. Hypertension.

The abundance of drugs now available for treating hypertension, and evidence that small reductions in blood pressure reverse the associated risk of stroke have shifted clinical concerns away from hypertension. However, we do not understand the cause of hypertension in 95% of patients, fail to achieve a normal blood pressure in 50% of patients, and are unable fully to reverse the cardiac and vascular changes that predate the diagnosis and treatment of hypertension. Consequently, hypertension remains the commonest cause of strokes in Britain and of renal failure in the United States. Essential hypertension is a polygenic disease whose understanding can now be advanced through molecular genetic analyses. Several different syndromes are likely to be recognised; most will be due to interactions between genetic and environmental factors, but there are also likely to be further monogenic syndromes in families with multiple affected members. Recognition of these syndromes will permit accurate genetic prediction of prognosis and optimal treatment and perhaps lead to new and more powerful classes of antihypertensive treatment.     

Science,medicine, and the future. Prospecting for gold in the human genome.

Doctors struggling with the daily problems of clinical medicine usually have little time for molecular and cell biology. But genetic research is producing an explosion of knowledge which doctors will need to understand in order to join in the ethical and financial debates that will inevitably follow the new treatments discovered. There may, indeed, be therapeutic gold hidden in our genes, but the price for it could be more than we can afford. This is the first of three articles introducing a series which aims to convey the excitement and potential power of biomedical science by speculating how current research will impinge on clinical management of common conditions.