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Related Experiment Videos

Glomerular hyperfiltration in hypertensive African Americans.

T A Kotchen1, A W Piering, A W Cowley

  • 1Departments of Medicine, Physiology, and Epidemiology, the Medical College of Wisconsin, Milwaukee, WI 53226, USA.

Hypertension (Dallas, Tex. : 1979)
|March 18, 2000
PubMed
Summary

African Americans with hypertension exhibit higher baseline kidney function and an exaggerated glomerular filtration rate response to norepinephrine, suggesting glomerular hyperfiltration contributes to their increased risk of kidney failure.

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Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Hypertension Research

Background:

  • Hypertension disproportionately affects African Americans, leading to a 5-fold higher incidence of end-stage renal disease compared to whites.
  • The role of glomerular hyperfiltration as a precursor to renal failure in this population requires further investigation.

Purpose of the Study:

  • To investigate whether glomerular hyperfiltration precedes renal failure in hypertensive African Americans.
  • To compare renal hemodynamics and glomerular filtration rate responses to norepinephrine infusion between African Americans and French Canadian whites with essential hypertension.

Main Methods:

  • 29 African Americans and 33 French Canadian whites with essential hypertension underwent graded norepinephrine infusions.
  • Renal blood flow and glomerular filtration rate were measured using para-aminohippuric acid (PAH) and inulin clearance, respectively.

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  • 24-hour ambulatory blood pressure monitoring was performed, and participants discontinued antihypertensive medications for at least one week prior to the study.

    • Main Results:

    • African Americans had higher baseline renal blood flow and glomerular filtration rate compared to French Canadians.
    • Norepinephrine infusion increased blood pressure similarly in both groups, with autoregulated renal blood flow.
    • Glomerular filtration rate significantly increased in African Americans during norepinephrine infusion, but not in French Canadians.
    • African Americans showed a lack of nocturnal blood pressure decline, unlike French Canadians.

    Conclusions:

    • Elevated baseline glomerular filtration rate and its further increase in response to norepinephrine in African Americans suggest glomerular hyperfiltration.
    • Glomerular hyperfiltration and the absence of nocturnal blood pressure dipping may be key factors contributing to the higher prevalence of end-stage renal disease in hypertensive African Americans.