Inter-related and interdependent pathophysiological adaptations combine to create the clinical problem of essential hypertension. This review outlines the continuing work on vascular neuroeffector mechanisms, the use of modern molecular biological techniques, and the role of the endothelium in the regulation and generation of hypertension. Current anti-hypertensive strategies have introduced calcium antagonism and angiotensin-converting enzyme inhibition to the frontline of attention. The demonstration of organ-specific auto-antibodies in dilated cardiomyopathy introduces an exciting era of immuno- and anti-viral chemotherapy.