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Is hypertension a disorder of volume control? What is the evidence?

Graeme Mindel1, Aubrey R Morrison

  • 1Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.

Nephron. Physiology
|July 16, 2005
PubMed

Insights

Kidney function and salt balance are key to hypertension. Low birth weight may predispose individuals to high blood pressure later in life due to altered kidney development and salt transport.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Genetics

Background:

  • Hypertension is complex, with the kidney playing a significant role.
  • Monogenic disorders affecting Na+ balance and volume expansion are linked to hypertension.
  • Epidemiological data show a correlation between high salt excretion and hypertension incidence.

Purpose of the Study:

  • To explore the etiological factors of the hypertensive phenotype.
  • To investigate the role of intrauterine factors, such as low birth weight, in hypertension development.
  • To examine the physiological mechanisms linking low birth weight, kidney function, and hypertension.

Main Methods:

  • Review of genetic studies on monogenic inheritance related to hypertension.
  • Analysis of epidemiological data on salt excretion and hypertension.
  • Examination of experimental data on low birth weight, kidney transporters, and nephron number.

Main Results:

  • Low birth weight is associated with increased hypertension risk later in life.
  • Upregulation of Na+/K+/2Cl- and thiazide-sensitive transporters observed in low birth weight animals.
  • Low birth weight correlates with decreased nephron number, potentially affecting volume homeostasis.

Conclusions:

  • Intrauterine imprinting and low nephron number may contribute to hypertension development.
  • Adaptive changes in utero influence later-life volume homeostasis.
  • Subtle transporter mutations can unmask volume homeostasis defects with increased salt intake.

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