Abstract
In this paper we have presented briefly three different aspects of arterial pressure regulation and of the hypertension problem: (1) the basic principles of arterial pressure control, progressing from simple, individual regulatory mechanisms to complex interactions between these mechanisms; (2) several systems analyses of arterial pressure regulation and of hypertension, also progressing from simple to complex; and (3) animal and human verification of both the logical principles and the systems analyses.
Both the systems analyses and the experiments on which they are based show that different feedback control mechanisms are responsible for acute versus long-term control of arterial pressure. Furthermore, some of the concepts of pressure control based on acute experiments and then extrapolated to the problem of hypertension have proved to be wrong, such as the widely heralded concept that chronic hypertension is “caused by” increased total peripheral resistance. Though, on the surface, this concept has long appeared to be a logical one, the systems analysis approach has made it possible to differentiate between the primary causes of hypertension and dependent variables of the system. The basic causes of chronic hypertension predicted by the analyses are: (1) abnormally low renal output of water and electrolytes (mainly salt) at each arterial pressure level, and (2) excess net intake of water and electrolytes. Other causes of chronic hypertension must operate by affecting one of these two basic effects. Total peripheral resistance is one of the dependent variables of the pressure control system, as is also cardiac output, but is never a primary determinant of the long-term level of arterial pressure.
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This work supported by NIH Grants HL 11678 and HL 08375.
This paper is based on the ALZA lecture given by Arthur C. Guyton before the Annual Meeting of the Biomedical Engineering Society in Baltimore, Marylan, April 7, 1972.
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Guyton, A.C., Coleman, T.G., Cowley, A.W. et al. Systems analysis of arterial pressure regulation and hypertension. Ann Biomed Eng 1, 254–281 (1972). https://doi.org/10.1007/BF02584211
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DOI: https://doi.org/10.1007/BF02584211