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The renal circulation in hypertensive disease

N K Hollenberg, D F Adams

    The American Journal of Medicine
    |May 31, 1976
    PubMed
    Summary

    The kidney plays a crucial role in hypertension. Renal vascular abnormalities are common in essential hypertension, affecting sympathetic nervous system activity and extracellular fluid volume perception.

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    Area of Science:

    • Nephrology
    • Cardiovascular Medicine
    • Hypertension Research

    Background:

    • The kidney's role in maintaining hypertension is increasingly recognized.
    • The renal vasculature's involvement in both renal vascular and essential hypertension has been a long-standing area of research.
    • Functional abnormalities in renal vascular tone are implicated in hypertension pathogenesis.

    Purpose of the Study:

    • To review evidence for functional abnormalities in the renal vasculature in essential hypertension.
    • To identify distinct patient groups with characteristic renal vascular abnormalities.
    • To explore the contribution of the renal vasculature to hypertension severity and therapeutic response.

    Main Methods:

    • Review of existing evidence on renal vascular tone and sympathetic nervous system activity in hypertension.
    • Identification and characterization of patient subgroups based on hypertension severity, therapeutic response, and renal hemodynamics.
    • Analysis of renal blood flow, glomerular filtration rate, renin secretion, and vascular responsiveness to vasodilators and volume challenges.

    Main Results:

    • Approximately two-thirds of essential hypertension patients exhibit increased renal vascular tone, potentially linked to sympathetic activity.
    • Two distinct patient groups with renal vascular abnormalities were identified: one with severe, resistant hypertension and reduced renal function, and another with inappropriately increased renal blood flow and altered volume perception.
    • Advanced arteriolonephrosclerosis was suggested in severe hypertension cases, contributing to disease progression.
    • Renal vascular abnormalities, including increased tone or organic changes, are common in essential hypertension, with a normal renal arterial tree being unusual.

    Conclusions:

    • The renal vasculature is frequently abnormal in essential hypertension, contributing to disease pathogenesis and severity.
    • Specific renal vascular abnormalities are associated with distinct clinical presentations and therapeutic responses.
    • Understanding these renal vascular roles is critical for managing hypertension effectively.

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