Are There Markers for the Physiopathology of Essential Hypertension?
Widespread interest for the physiopathology of hypertension has undoubtedly been raised by the hope of understanding the error or the errors of regulation by which higher blood pressure values are attained, but this cognitive interest has often been coupled with the hope that improved Physiopathologic understanding might result in improved management of hypertension. This practical interest is linked with the belief that qualitatively or, at least, quantitatively different mechanisms underlie the rise in blood pressure in different patients. The hope of learning the best individual treatment for a given physiopathological profile requires a process of simplification, that is the identification of simple but meaningful indices, or markers, from which a more complex functional pattern can be described. The question mark in the title of this lecture “Are there markers for the physiopathology of essential hypertension?” has been placed to signify the uncertainty as to whether any of the markers that have been proposed and used really measures the function we assume that it measures, whether other functional variables have a fixed relation with the supposed marker and can be inferred from measurement of the latter, and finally whether useful therapeutic guidelines can be derived from its measurement.
KeywordsMean Arterial Pressure Essential Hypertension Plasma Noradrenaline Carotid Sinus Sympathetic Muscle Nerve Activity
Unable to display preview. Download preview PDF.
- 9.G. Mancia, G. Leonetti, G. B. Picotti, A. Ferrari, M. D. Galva, L. Gregorini, G. Parati, G. Pomidossi, C. Ravazzani, C. Sala and A. Zanchetti, Plasma catecholamines and blood pressure responses to the carotid baroreceptor reflex in essential hypertension, Clin. Sci., 57, Suppl. 5:156 (1979).Google Scholar
- 11.J. Brod, Essential hypertension. Haemodynamic observations with a bearing on its pathogenesis, Lancet, 1:733 (1960).Google Scholar
- 14.L. H. Tung, M. J. Rand and H. Majewski, Adrenaline-induced hypertension in rats, Clin. Sci., 61, Suppl. 7:191 (1981).Google Scholar
- 15.D. C. Tosteson, N. Adragna, I. Bize, H. Solomon and M. Canessa, Membranes, ions and hypertension, Clin. Sci., 61, Suppl. 7:5 (1981).Google Scholar
- 16.Y. Postnov and S. Orlov, Alterations of cell membranes in primary hypertension, Proc. IX World Congress of Cardiology, in press.Google Scholar
- 17.F. Wessels, G. Junge-Hulsing and H. Losse, Untersuchungen zur Natriumpermeabilität der Erythrozyten bei Hypertonikern und Normotonikern mit familiärer Hochdruckbelastung, Z. Kreislauf-forsch., 56:374 (1967).Google Scholar
- 21.R. P. S. Edmonsom, R. D. Thomas, P. J. Hilton, J. Patrick and N. F. Jones, Abnormal leucocyte composition and sodium transport in essential hypertension, Lancet, 1:1003 (1975).Google Scholar
- 22.E. Ambrosioni, L. Tartagni, L. Montebugnoli and B. Magnani, Intralymphocytic sodium in hypertensive patients: a significant correlation, Clin. Sci., 57, Suppl. 5:325 (1979).Google Scholar
- 25.M. Canali, L. Borghi, E. Sani, A. Curti, A. Montanari, A. Novarini and A. Borghetti, Increased erythrocyte lithium-sodium countertransport in essential hypertension: its relationship to family history of hypertension, Clin. Sci., 61, Suppl. 7:13 (1981).Google Scholar
- 26.D. Cusi, C. Barlassina, M. Ferrandi, P. Palazzi, E. Celega and G. Bianchi, Relationship between altered Na+-K+ co-transport and Na+-Li+ countertransport in the erythrocytes of essential hypertensive patients, Clin. Sci., 61, Suppl. 7:33 (1981).Google Scholar
- 29.P. L. Padfield, D. G. Beevers, J. J. Brown, D. L. Davies, R. Fraser, A. F. Lever, J. I. S. Robertson, M. A. D. H. Schalekamp, G. Kolsters and W. H. Birkenhäger, Low renin hypertension: a diagnostic entity attributable to mineralocorticoid excess?, in: “Hypertension — its nature and treatment”, D. M. Burley, G. F. B. Birwood, J. M. Fryer, S. H. Taylor, eds., p. 135, Ciba, Horsham (1975).Google Scholar
- 30.A. Zanchetti, A. Stella, G. Leonetti, A. Morganti and L. Terzoli, Control of renin release: experimental evidence and clinical implications, in: “Topics in hypertension”, J. H. Laragh, ed., chapter 7, Yorke Medical Books, New York (1980).Google Scholar
- 31.C. Beretta-Piccoli, D. L. Davies, K. Boddy, J. J. Brown, A. M. M. Cumming, B. W. East, R. Fraser, A. F. Lever, P. L. Padfield, P. F. Semple, J. I. S. Robertson, P. Weidmann and E. D. Williams, Relation of arterial pressure with body sodium, body potassium and plasma potassium in essential hypertension, Clin. Sci., 63:257 (1982).PubMedGoogle Scholar
- 32.F. R. Bühler, J. H. Laragh, E. D. Vaughan Jr., H. R. Brunner, H. Gavras and L. Baer, Antihypertensive action of propranolol. Specific antirenin responses in high and normal renin forms of essential, renal, renovascular and malignant hypertension, Am. J. Cardiol., 32:511 (1973).PubMedCrossRefGoogle Scholar
- 33.A. Zanchetti, G. Leonetti, L. Terzoli and C. Sala, Beta-blockers and renin, in: “Beta Blockade in the 1980s”, in publication.Google Scholar
- 35.A. Zanchetti, Essential hypertension today and tomorrow, in: “Blood pressure measurement and systemic hypertension”, A. C. Arntzenius, A. J. Dunning, H. A. Snellen, eds., p. 261, Medical World Press, Breda (1981).Google Scholar