Abnormal pressure natriuresis. A cause or a consequence of hypertension?

J. E. Hall, H. L. Mizelle, D. A. Hildebrandt, M. W. Brands

Research output: Contribution to journalReview article

169 Scopus citations

Abstract

In all forms of chronic hypertension, the renal-pressure natriuresis mechanism is abnormal because sodium excretion is the same as in normotension despite the increased blood pressure. However, the importance of this resetting of pressure natriuresis as a cause of hypertension is controversial. Theoretically, a resetting of pressure natriuresis could necessitate increased blood pressure to maintain sodium balance or it could occur secondarily to hypertension. Recent studies indicate that, in several models of experimental hypertension (including angiotensin II, aldosterone, adrenocorticotrophic hormone, and norepinephrine hypertension), a primary shift of renal-pressure natriuresis necessitates increased arterial pressure to maintain sodium and water balance. In genetic animal models of hypertension, there also appears to be a resetting natriuresis before the development of hypertension. Likewise, essential hypertensive patients exhibit abnormal pressure natriuresis, although the precise cause of this defect is not clear. It is likely that multiple renal defects contribute to resetting of pressure natriuresis in essential hypertensive patients. With long-standing hypertension, pathological changes that occur secondary to hypertension must also be considered. By analyzing the characteristics of pressure natriuresis in hypertensive patients and by comparing these curves to those observed in various forms of experimental hypertension of known origin, it is possible to gain insight into the etiology of this disease.

Original languageEnglish (US)
Pages (from-to)547-559
Number of pages13
JournalHypertension
Volume15
Issue number6 I
DOIs
StatePublished - 1990
Externally publishedYes

Keywords

  • angiotensin
  • blood pressure
  • essential hypertension
  • kidney
  • renin atrial natriuretic factor
  • sodium excretion

ASJC Scopus subject areas

  • Internal Medicine

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