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August 3, 1963

ESSENTIAL Hypertension: Two basic causal mechanisms—the defect in catecholamine metabolism and concentration of sodium in vascular smooth muscle

JAMA. 1963;185(5):34-35. doi:10.1001/jama.1963.03060050010006

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Two basic causal mechanisms—a defect in catecholamine metabolism and a concentration of sodium in vascular smooth muscle—have emerged from "the welter of research" in essential hypertension, in the opinion of Dr. Milton Mendlowitz of the Department of Medicine at Mount Sinai Hospital in New York.

Speaking at the American College of Chest Physicians meeting in Atlantic City, Mendlowitz offered the following evidence that a basic abnornality of catecholamine metabolism exists in essential hypertension:

"Most successful therapy in essential hypertension influences the catecholamine complex in one way or another, resulting in a decrease in free l-norepinephrine (NE) available for vasoconstriction. The drugs may inhibit release of NE, deplete stores, or compete with effector sites, and are usually more effective in hypertensive than in normotensive states.

"Second, the systemic blood vessels of patients with hypertension and even of their offspring are more reactive to NE as well as to other vasoactive

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