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This is a Festschrift to Professor Sir Stanley Peart, Professor of Medicine at St. Mary's Hospital and Medical School, University of London since 1956, who has influenced and directed many of us in the better understanding of the patho physiological basis and the clinical practice of hypertension. It commemorates, and we hope will preserve, memories of a special occasion when we met to honour him at the Castella de Pomeiro, Como, Italy. At this meeting his "extended family" (pictured above) shared experiences, discussed current scientific and clinical ap proaches in hypertension research and indulged in reminiscences of their exciting times on his Unit at St. Mary's. We particularly hope that this volume will illustrate the multifaceted approach needed in investigating and managing hypertension and that it will additionally remind Sir Stanley of the admiration and warm affection with which he has been, and will always continue to be regarded. Christopher J. Mathias Peter S. Sever Introduction P. S. Sever Welcome to Castello de Pomerio, for what I feel sure is to be a very special occasion. As all of you know, Stan Peart is retiring after 31 years as professor and head of the department of Medicine at St. Mary's, and after nearly 40 years of distinguished research in basic and clinical science related to the cardiovascular system, the kidney and particularly to hypertension.
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There is clear evidence that in severe hypertension lowering blood pressure, by drug therapy decreases the incidence of major cardiovascular events. Recent studies suggest that such benefit may also extend to patients with mild to moderate hypertension. The putative benefits of drugs may be offset, however, by their adverse effects and a prime example is the increased incidence of impotence and metabolic disorders in patients on thiazide diuretics. There is, therefore, a real need to look further into the therapy of patients with mild to moderate hypertension. The ideal drug in such patients would oppose the basic mechanisms responsible for the elevation in blood pressure, would prevent counter-regulatory responses and would have minimal side-effects in both the short-term and the long-term, the latter being of particular importance to younger patients. These aspects were considered at the symposium "Mild hypertension. Current con troversies and new approaches" held at Titisee in West Germany, October 13-15 in 1983. The foundation for discussion was set with an exposition of the neural and hormonal regulation of blood pressure in normal man followed by a consideration of the pos~ible pathophysiological mechanisms involved in patients with hypertension. Particular at tention was focused on the central nervous system and on effects governed by activity of the peripheral nervous system as these may well provide further opportunities for logical therapeutic intervention in clinical hypertension. The current management of mild to moderate hypertension was then reviewed.