An update on immune system activation in the pathogenesis of hypertension.

Abstract

Hypertension remains as an enormous health and economic burden in the United States despite the large number of antihypertensive treatments that are available.1 In addition, the prevalence of uncontrolled hypertension continues to rise globally,2 suggesting that that there is an important need to better understand the underlying causes of this disease. An association between hypertension and immune system activation has long been recognized, but perhaps not fully appreciated until now, and represents a potentially important mechanism in the pathogenesis of hypertension. Studies of human hypertension support this association and implicate a mechanistic role for immune activation and inflammation in the development of hypertension.3–8 Experimental animal models have proven especially useful for determining the impact of specific immune cells (innate and adaptive immunity) and cytokines, with a heavy emphasis on angiotensin II (AngII)–dependent hypertension in rodent models.9–17 Hypertension has been, and continues to be, one of the leading journals for studies that have accelerated our understanding of immune regulation of blood pressure, having already provided excellent overviews of basic immune responses and their interaction with the cardiovascular system.18–20 The objective of this brief review is to discuss the most recent advances published in Hypertension that relate to immune system activation and the pathogenesis of hypertension. Because blood pressure is regulated by the integrated function of the kidneys, central nervous system, and vasculature, the review will focus on the potential for inflammatory mediators to impact each of these organ systems. The central role of the kidneys in long-term blood pressure control through the regulation of body fluid and salt homeostasis is widely recognized. This is supported by work showing that the ability of the kidneys to excrete a sodium load is impaired, regardless of whether the origins of hypertension are vascular, …