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[Hypertension and its related organ damage--pathophysiology and new diagnostic strategy]
1Department of Clinical Laboratory, The University of Tokyo School of Medicine, Bunkyo-ku, Tokyo 113-8655, Japan. tshimo-tky@umin.ac.jp
Insights
Salt-sensitive hypertension, common in Asians, worsens prognosis despite blood pressure control. Understanding its link to mineralocorticoid receptor activity and oxidative stress is key for better diagnosis and treatment.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Context:
- Hypertension is a leading non-communicable disease globally.
- Despite advances in antihypertensive therapies, hypertension-related morbidity and mortality, particularly from renal failure and stroke, remain high in Japan.
- Current treatment strategies may not adequately address the underlying pathophysiology or organ damage severity.
Purpose:
- To highlight the importance of understanding salt-sensitive hypertension's pathophysiology.
- To explore recent research linking mineralocorticoid receptor activity and sympathetic overactivity to salt sensitivity and organ damage.
- To identify novel diagnostic and therapeutic avenues for hypertension.
Summary:
- Salt-sensitive hypertension, prevalent in Asian populations, is associated with a poorer prognosis than resistant hypertension, irrespective of blood pressure control.
- Emerging research indicates that aldosterone-independent mineralocorticoid receptor activity contributes to salt-sensitive hypertension and organ damage, often mediated by oxidative stress.
- Sympathetic overactivity, potentially influenced by epigenetic modulation, is also implicated in salt sensitivity.
Impact:
- This research underscores the need for improved diagnostic tools to identify salt sensitivity and assess organ damage.
- Focusing on mineralocorticoid receptor function and epigenetic markers may lead to personalized, tailor-made therapies for hypertension.
- Advances in understanding salt sensitivity could significantly reduce hypertension-related morbidity and mortality, especially in susceptible populations.
Abstract:
Hypertension is the most common non-communicable disease. Although novel therapeutic agents have become available and blood pressure tends to be lowered, the morbidity and mortality rates of hypertension-induced renal failure or stroke in Japan have not decreased in recent decades. This might be because we cannot choose appropriate therapy based upon the pathophysiology of high blood pressure and the degree of organ damage. Salt-sensitive hypertension has a poorer prognosis than resistant hypertension regardless of blood pressure control and is more common in Asians than in Caucasians. Therefore, understanding the pathophysiology of salt sensitivity and diagnosing it is very important. Recent advances in research into salt-sensitive hypertension revealed that mineralocorticoid receptor activities independent of aldosterone induce both salt-sensitive hypertension and organ damage, which is closely related to oxidative stress. In an other study, sympathetic overactivity was related to salt sensitivity via epigenetic modulation. Current research into new surrogate markers is mostly focused on hunting for humoral factors, and novel directions to evaluate receptor functions such as mineralocorticoid receptor or epigenetic modulations would open a new door for the early diagnosis of organ damage and tailor-made therapy.
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