The extra-cellular-matrix in hypertension: the link between renal function, autoregulation and sodium metabolism, a...

In this paper the nature of the extra-cellular-matrix (ECM) is outlined briefly. Changes in the ECM in hypertension have been reviewed as has their possible involvement in the pathophysiological process of hypertension. It appears that significant and widespread changes occur in the ECM in hypertensive states. Such changes may alter the characteristics of (1) the renal perfusion pressure/sodium excretion curve (2) autoregulation and (3) sodium metabolism, all of which have been implicated in the pathogenesis of hypertension. The ECM may well be the link between these three. The ECM changes will also contribute to many of the differences, e.g. altered fluid distribution, altered handling of a sodium load, altered electrolyte and water content of vascular tissue, and altered passive and active mechanical properties of vascular tissue seen in hypertensive states. The ECM changes are unlikely to be the root cause of hypertension but are a more fundamental difference than altered renal perfusion/excretion characteristics, altered fluid distribution etc. Indeed the perfusion/excretion characteristics, fluid distribution etc. appear to be dependent upon the properties of the ECM. What now requires to be done is to determine what controls the properties of the ECM and to determine what fault in the control may lead to the changes which could ultimately manifest themselves as hypertension.