We review the present knowledge of risk factors for arterial hypertension.
Both genetic and environmental factors as well as their interaction and bio
logical plausibility are reviewed. Recent data confirm that the interaction
of genetics with multiple environmental risk factors explains the high pre
valence of hypertension in the industrialised countries. The most important
modifiable environmental risk factors are high salt intake, alcohol intake
, obesity and low physical activity.
The role of stress in the aetiology of high blood pressure is still under i
nvestigation, but recent clinical experimental and epidemiological data hav
e shed light on how stress could be related to hypertension.
The implications for prevention and treatment are discussed both at the pop
ulation and individual levels. The population approach involves a public he
alth policy aiming at modification of the major risk factors. The individua
l approach involves nonpharmacological measures to prevent the development
of hypertension and to treat high normal blood pressure and mild hypertensi
on with no additional cardiovascular risk factors, pharmacological treatmen
t of hypertension in most individuals should use agents that have been prov
en to be effective in randomised controlled trials with 'hard' endpoints su
ch as cardiovascular and cerebrovascular morbidity and mortality.