A genetic influence on blood pressure was demonstrated more than 100years ago and asimple Mendelian inheritance was initially presumed. Platt and Pickering conducted alively debate on this topic. Platt favored the idea that a single gene or only a few genes were responsible for high blood pressure. Pickering presented research results, which supported the assumption that many genes exerted an influence on blood pressure. This was all in a period when it was not even known what genes were. Genome-wide association studies (GWAS) according to the Pickering model have identified > 500 blood pressure relevant gene loci, which are distributed over the whole genome. Each individual gene exerts only asmall effect on blood pressure. The dark horses of hypertension research are the secondary causes. In pheochromocytoma, primary aldosteronism, Cushing's syndrome and even fibromuscular dysplasia (renovascular hypertension) the results indicate that a genetic cause regularly underlies secondary hypertension. This would therefore also partially confirm Platt's theory. In the meantime, a multitude of forms of hypertension have been described with a genetic inheritance according to Mendel. Each of these genetic variants exerts a considerable influence on blood pressure. A multitude of novel physiological mechanisms were explained by this. These findings will become therapeutically important. Therefore, it is incumbent upon clinicians to be optimally informed about these research results.

An 83-year-old male presented with syncope and acute coronary syndrome. An electrocardiogram (ECG) suggested left main (LM) coronary artery stenosis; angiography confirmed aheavily calcified tight LM stenosis. Percutaneous coronary intervention was performed using intravascular lithotripsy and implantation of drug eluting stents with an excellent angiographic result, resolution of symptoms and ECG changes. Intravascular lithotripsy is anew and easily applicable method for heavily calcified coronary lesions. Cost-effectiveness and long-term results will define its future role.