Abstract: Arterial hypertension might primarily relate to disturbances of oxygen delivery and of blood flow that arise and progress further as ischemic phenomena of vascular myofibers and of focal regions in tissues of supply. Indeed, one might speak of a centrally operative mechanistic pathway of ischemic phenomena that act as predeterminants in inducing instability of hemodynamic blood flow and of perfusion pressure characterizing the arterial hypertensive state. A concept of strictly multigenic determinants primarily inducing various different organ pathologies ranging from kidneys to myocardium to brain would essentially constitute a paradoxical congenic aggregate clustering of effects that progresses specifically as a single pathway of ischemic effect. Beyond considerations even of thrombogenicity or of embolism in a context of progressive atherosclerosis or of diabetic disease, arterial hypertension might be recognized as progressing in terms of endresult involvement of multiple different organs. The essential Hypertensive state might incorporate a tendency for interactivity of pathologies primarily affecting kidneys, myocardium and brain. Within any simple context of Na imbalance or + of dysregulation of various hemodynamic parameters, the association of kidney disease with progressive hemodynamic stress would progress towards pathways of vascular wall damage and rupture. The intracranial hemorrhages of hypertensive type, as constituted by intracerebral bleeds and subarachnoid berry aneurysms, would involve progressive tissue Ischemia. Indeed, Binswanger’s disease would constitute one example of how perivascular tissue Ischemia is a prime pathogenesis towards hemodynamic instability of hypertensive type.