Hipertensión arterial y riñón

Abstract

Hypertension (HT) is the main cause of death in the world. It is maintained thanks to the dysfunction of different organs and systems that normally take part in controlling blood pressure (BP) to ensure adequate perfusion of the tissues. The kidneys are the main regulators of BP over the long-term. A strict balance between the production and metabolism of vasoactive substance that regulate the excretion of water and sodium through the renin-angiotensin-aldosterone system (RAAS) modulates BP. Nevertheless, new mechanisms described in the last decade could also explain the variability of BP in patients. The overexpression of sodium cotransporters at renal level seems to escape from the regulatory effect of the RAAS. Moreover, the immune system and intestinal microbiota seem to play an important and newly discovered role. The production of certain inflammatory cytokines promotes the tubular reabsorption of sodium and the intrarenal over-activation of the RAAS. The proliferation of fermicutes, proteobacterias and Prevotella in subjects with salt-sensitive HT predisposes them to more difficult control of BP. Studying these new mechanisms may not only discover new treatment targets, as it may also explain why the improvement in BP control was not enough to reduce the comorbidities and cardiovascular risk associated with HT.