Neural regulation of renin release: experimental evidence and clinical implications in arterial hypertension

The assessment of the possible role played by the renin-angiotensin system in maintaining arterial hypertension requires an understanding of the mechanisms regulating renin release from the kidney. In addition to intrarenal mechanisms of control, recent investigation stresses the importance of sympathetic influences on the juxtaglomerular cells both in experimental animals and in man. Studies with beta-adrenergic blocking agents, interfering with sympathetic release of renin, and with peptides interfering with sympathetic release of renin, and with peptides interfering with the generation or action of angiotensin II, suggest that renin may play some pressor role in a number of cases of hypertension: a major one in the small group of patients with high plasma renin, and possibly a minor one in the large population of patients whose renin is stimulated by treatment with diuretics and vasodilators. On the whole, available evidence suggests that renin disturbances in essential hypertension are rarely primary. It is unlikely, therefore, that renin levels alone can suffice as guideline for treatment of hypertension. A more comprehensive approach should be based on a multifaceted profile, including but not limited to renin.