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Hypertension and the kidney

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Abstract

Hypertension and kidney function are intimately related, with each having significant influences on the other. Given the major role played by the kidney in maintenance of extracellular fluid volume and peripheral vascular resistance, the kidney is justifiably a target of investigation to determine its potential role in essential hypertension. Conversely, hypertension is associated with progressive renal failure, and hypertension-associated end-stage renal disease is the second leading cause of end-stage renal disease in the United States. It is therefore important that we continue to investigate the hypertension/renal relationship in an effort to better understand the determinants of essential hypertension and to prevent a major cause of end-stage renal disease.

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References and Recommended Reading

  1. National High Blood Pressure Education Program Working Group: 1995 Update of the working group reports on chronic renal failure and renovascular hypertension. Arch Intern Med 1996, 156:1938–1947.

    Article  Google Scholar 

  2. Tarif N, Bakris GL: Renal components of the hypertensive syndrome. J Cardiovasc Risk 1997, 4:271–277.

    Article  PubMed  CAS  Google Scholar 

  3. Glynn RJ, Field TS, Rosner B, et al.: Evidence for a positive linear relationship between blood pressure and mortality in elderly people. Lancet 1995, 345:825–829.

    Article  PubMed  CAS  Google Scholar 

  4. Klag MJ, Whelton PK, Randall BL, et al.: Blood pressure and endstage renal disease in men. N Engl J Med 1996, 334:13–18.

    Article  PubMed  CAS  Google Scholar 

  5. Mann JFE, Gerstein HC, Pogue J, et al.: Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: The HOPE Randomized Trial. Ann Intern Med 2001, 134:629–636. This landmark study showed that angiotensin converting enzyme inhibitor therapy reduces the elevated cardiovascular risk of EH patients with HAN. It also confirmed that cardiovascular risk is elevated in EH patients with HAN above that of EH patients with normal renal function.

    PubMed  CAS  Google Scholar 

  6. US Renal Data System: USRDS 2000 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1999.

    Google Scholar 

  7. Hall JE, Brands MW, Shek EW: Central role of the kidney and abnormal fluid volume control in hypertension. J Hum Hypertens 1996, 10:633–639. This study extended the classic observations of Arthur Guyton and expanded understanding of the phenomenon known as pressure natriuresis.

    PubMed  CAS  Google Scholar 

  8. Guidi E, Menghetti D, Milani S, et al.: Hypertension may be transplanted with the kidney in humans: a long term historical prospective follow-up of recipients grafted with kidneys coming from donors with or without hypertension in their families. J Am Soc Nephrol 1996, 7:1131–1138.

    PubMed  CAS  Google Scholar 

  9. Stamler J, Rose G, Elliott P: Findings of the International Cooperative INTERSALT study. Hypertension 1991, 17:I9-I17.

    PubMed  CAS  Google Scholar 

  10. Weinberger M: Salt sensitivity of blood pressure in humans. Hypertension 1996, 27:481–490.

    PubMed  CAS  Google Scholar 

  11. Campese V: Salt sensitivity in hypertension: renal and cardiovascular implications. Hypertension 1994, 23:2531–2550.

    Google Scholar 

  12. Redgrave JE, Rabinowe SL, Hollenberg NK: Correction of abnormal renal blood flow response to angiotensin II by converting-enzyme inhibition in essential hypertension. J Clin Invest 1985, 75:1285–1290.

    PubMed  CAS  Google Scholar 

  13. Adviye E: Hypertension in black patients: an emerging role of the endothelin system in salt-sensitive hypertension. Hypertension 2000, 36:62–67.

    Google Scholar 

  14. Sealy JE, Blumenfeld JD, Bell GM, et al.: On the basis for essential hypertension: nephron heterogeneity with discordant renin secretion and sodium excretion causing a hypertensive vasoconstricting-volume relationship. J Hypertens 1988, 6:763–777.

    Article  Google Scholar 

  15. Whelton PK, He J, Perneger TV, Klag MJ: Kidney damage in "benign" essential hypertension. Curr Opin Nephrol Hypertension 1997, 6:177–183.

    Article  CAS  Google Scholar 

  16. Kojima S, Yoshitomi Y, Yano Michiko Y, et al.: Heterogeneity of renal cortical circulation in hypertension assessed by dynamic computer tomograhy. Am J Hypertens 2000, 13:346–352.

    Article  PubMed  CAS  Google Scholar 

  17. Helmchen U, Wenzel UO: Benign and malignant nephrosclerosis and renovascular disease. In Renal Pathology. Edited by Tisher CC, Brenner BM. Philadelphia: JB Lippincott Company; 1994:1201.

    Google Scholar 

  18. Campese V: The kidney and the neurogenic control of blood pressure in renal disease. J Nephrol 2000, 13:221–224.

    PubMed  CAS  Google Scholar 

  19. Converse RL Jr, Jacobsen TN, Toto RD, et al.: Sympathetic overactivity in patients with chronic renal failure. N Engl J Med 1992, 327:1912–1918.

    Article  PubMed  Google Scholar 

  20. Brenner B, Garcia D, Anderson S: Glomeruli and blood pressure: Less of one, more the other? Am J Hypertens 1988, 1:335–347.

    PubMed  CAS  Google Scholar 

  21. dePaula RB, Plavnik FL, Rodriques CI, et al.: Contribution of vasopressin to orthostatic blood pressure maintenance in essential hypertension. Am J Hypertens 1993, 6:794–798.

    CAS  Google Scholar 

  22. Barri YM, Wingo CS: The effects of potassium depletion and supplementation on blood pressure: a clinical review. Am J Med Sci 1997, 314:37–40.

    Article  PubMed  CAS  Google Scholar 

  23. Sudhir K, Froman A, Yi S, et al.: Reduced dietary potassium reversibly enhances vaspressor response to stress in African Americans. Hypertension 1997, 29:1083–1090.

    PubMed  CAS  Google Scholar 

  24. Wesson DE: Na+/H+ exchange mediates increased distal tubule acidification in chronic alkalosis. Kidney Int 1998, 53:945–951.

    Article  PubMed  CAS  Google Scholar 

  25. Grim CE, Luft FC, Miller JZ, et al.: Racial differences in blood pressure in Evans County, Georgia: relationships to sodium and potassium intake and plasma renin activity. J Chron Dis 1980, 33:87–94.

    Article  PubMed  CAS  Google Scholar 

  26. Mattei P, Virdis A, Ghiadoni L, et al.: Endothelial function in hypertension. J Nephrol 1997, 10:192–197.

    PubMed  CAS  Google Scholar 

  27. Tracy RE, Berenson G, Wattigney W, Barrett TJ: The evolution of benign arterionephrosclerosis from age 6 to 70 years. Am J Pathol 1990, 136:429–439.

    PubMed  CAS  Google Scholar 

  28. Tracy RE: Blood pressure related separately to parenchymal fibrosis in vasculopaty in the kidney. Am J Kidney Dis 1992, 20:124–131.

    PubMed  CAS  Google Scholar 

  29. Tracy RE, Strong JP, Newman WPI, et al.: Renovasculopathies of nephrosclerosis in relation to atherosclerosis at age 25–54 years. Kidney Int 1996, 49:564–570.

    Article  PubMed  CAS  Google Scholar 

  30. Diamond JR: Analogous pathobiologic mechanisms in glomerulosclerosis and atherosclerosis. Kidney Int 1991 39(Suppl 31):S29-S34.

    Google Scholar 

  31. Blackshear JL, Garnic D, Williams GH, et al.: Exaggerated renal vasodialator response to calcium entry blockade in first degree relatives of essential hypertensive subjects. Hypertension 1987, 9:384–389.

    PubMed  CAS  Google Scholar 

  32. Ramirez AJ, Gimenez MI, Gallo G, et al.: Renal sodium handling abnormalities in hypertensive and normotensive patients with a family of hypertension. J Hypertens 1989, 7(Suppl 6):S178-S179.

    CAS  Google Scholar 

  33. Ruilope LM, Campo C, Rodicio JL: Relationship between blood pressure and renal function. J Hypertens 1994, 12(suppl 8):S55–59.

    CAS  Google Scholar 

  34. Tracy RE: Histologic characteristics of coronary artery in relation to renovasculopathies of hypertension. Ann Diagn Pathol 1998, 2:159–166.

    Article  PubMed  CAS  Google Scholar 

  35. Junker R, Heinrich J, Schulte H, et al.: Hemostais in normotensive and hypertensive men: results of the PROCAM Study. J Hypertens 1998, 16:917–923.

    Article  PubMed  CAS  Google Scholar 

  36. Erden Y, Usalan C, Haznedaroglu IC, et al.: Effects of angiotensin converting enzyme and angiotensin II receptor inhibition on impaired fibrinolysis in systemic hypertension. Am J Hypertens 1999, 11:1071–1076.

    Article  Google Scholar 

  37. Stewart DJ: Impact of endothelin-1 on vascular structure and function. Am J Cardiol 1998, 82:14S-16S.

    PubMed  CAS  Google Scholar 

  38. Lee LK, Meyer TW, Pollock AS, Lovett DH: Endothelial cell injury initiates glomerular sclerosis in the rat remnant kidney. J Clin Invest 1995, 96:953–964.

    Article  PubMed  CAS  Google Scholar 

  39. Lip GYH, Beevers DG: Abnormalities of rheology and coagulation in hypertension. J Hum Hypertens 1994, 8:693–702.

    PubMed  CAS  Google Scholar 

  40. Eliasson M, Jansson J-H, Nilsson P, Asplund K: Increased levels of tissue plasminogen activator antigen in essential hypertension. A population-based study. J Hypertens 1997, 15:349–356.

    Article  PubMed  CAS  Google Scholar 

  41. Levy PJ, Yunis C, Owen J, et al.: Inhibition of platelet aggregability by losartan I essential hypertension. Am J Cardiol 2000, 86:1188–1192.

    Article  PubMed  CAS  Google Scholar 

  42. Caetano EP, Zatz R, Praxedes JN: The clinical diagnosis of hypertensive nephrosclerosis-how reliable is it? Nephrol Dial Translant 1999, 14:288–290.

    Article  CAS  Google Scholar 

  43. Luft FC: Hypertensive nephrosclerosis-a cause of end-stage renal disease? Nephrol Dial Translant 2000, 15:1515–1517.

    Article  CAS  Google Scholar 

  44. Fogo A, Breyer JA, Smith MC, et al.: Accuracy of the diagnosis of hypertensive nephrosclerosis in African Americans: a report from the African American Study of Kidney Disease (AASK) Trial. AASK Pilot Study Investigators. Kidney Int 1997, 51:244–252. This studies describes renal pathology in the largest published cohort of black essential hypertensives with mild renal insufficiency, showing "classical" nephrosclerosis to be the predominant lesion.

    Article  PubMed  CAS  Google Scholar 

  45. Hilgers KF, Hartner A, Porst M, et al.: Monocyte chemoattractant protein-1 and macrophage infiltration in hypertensive kidney injury. Kidney Int 2000, 58:2408–2419.

    Article  PubMed  CAS  Google Scholar 

  46. Tharaux P-L, Chatziantoniou C, Casellas D, et al.: Vascular endothelin-1 gene expression and synthesis and effect on renal type I collagen synthesis and nephroangiosclerosis during nitric oxide synthase inhibition in rats. Circulation 1999, 99:2185–2191.

    PubMed  CAS  Google Scholar 

  47. Rizvi MA, Katwa L, Spadone DP, Myers PR: The effects of endothelin-1 on collagen type I and type III synthesis in cultured porcine coronary artery vascular smooth muscle cells. J Mol Cell Cardiol 1996, 28:243–252.

    Article  PubMed  CAS  Google Scholar 

  48. Massagne J: The transforming growth factor family. Ann Rev Cell Dev Biol 1990, 6:597–641.

    Article  Google Scholar 

  49. August P, Leventhal B, Suthanthiran M: Hypertension-induced organ damage in African Americans: transforming growth factor b1 excess as a mechanism for increased prevalence. Curr Hypertens Rep 2000, 2:184–191.

    PubMed  CAS  Google Scholar 

  50. Ligtenberg G, Blankestijn PJ, Oey PL, et al.: Reduction of sympathetic overactivity by enalapril in patients with chronic renal failure. N Engl J Med 1999, 340:1321–1328. These investigators show yet another benefit of angiotensin converting enzyme inhibitor therapy in the treatment of EH with HAN: reduced activity of the sympathetic nervous system.

    Article  PubMed  CAS  Google Scholar 

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Wesson, D.E. Hypertension and the kidney. Current Science Inc 3, 511–516 (2001). https://doi.org/10.1007/s11906-001-0014-x

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