Pathogenesis of hypertension and implications for its therapeutic management.

Abstract

Excluding elevations in blood pressure secondary to primary hemodynamic changes and the relatively rare disorders in which hypertension is an accompaniment of extrarenal disturbances, hypertensive cardiovascular disease is attributable to dysfunction of the kidney. In a small group of patients, the elevation in blood pressure is mediated or intensified by a circulating pressor agent secreted by the kidney and detectable in the untreated plasma of the renal venous effluent. This unidentified pressor agent differs from renin and angiotensin, neither of which plays a primary role in the pathogenesis of renal hypertension. Most cases of chronic hypertension, including essential hypertension, are attributable to the loss of a normal renal function concerned in the maintenance of the normotensive state. This fuction appears to be humoral in nature, and replacement therapy with this humoral agent affords the prospect of a rational approach to the effective therapy of essential and related forms of hypertensive cardiovascular disease.