Contribution of the adrenal cortex to renal and renoprival hypertension.

Abstract

Association of the adrenal cortex with renal hypertension lead to the conclusion that several mechanisms are operating. First, hypertension is not, or is poorly sustained in true adrenal failure, and mild failure seems to impair vascular responsiveness. This indicates a permissive function of the adrenal in renal hypertension. Furthermore, degrees of renal injury or of hypercorticoidism which are not of themselves very pressor may cause severe hypertension when they are added together. This additive aspect is probably closely related to the sensitizing effect of adrenal steroids on renal pressor activity and underlies the so-called renin-DCA syndrome. It may involve not only an enhanced pressor responsiveness but also a weakening of vessel walls. Lastly, the effects of renin and renal hypertension on the zona glomerulosa suggest that the renal pressor system has a direct effect on the adrenal cortex which would tend to add cortical pressor to existing renal pressor activity and thus sustain renal hypertension.