A unifying pathway for essential hypertension

• Published in: American Journal of Hypertension 2005-03, Vol.18 (3), p.431-440
• Main Authors: Johnson, Richard J., Rodriguez-Iturbe, Bernardo, Kang, Duk-Hee, Feig, Daniel I., Herrera-Acosta, Jaime
• Format: Article
• Language: English
• Subjects: Animals; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Experimental diseases; Humans; Hypertension, Renal - etiology; Hypertension, Renal - physiopathology; Hyperuricemia - complications; Hyperuricemia - physiopathology; Medical sciences; Oxidative Stress - physiology
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/j.amjhyper.2004.08.035

We present the hypothesis that most cases of essential hypertension occur via two phases. The first phase is initiated by episodes of renal vasoconstriction induced by a hyperactive sympathetic nervous system, activation of the renin-angiotensin system, or hyperuricemia resulting from diet or genetics. During this phase the hypertension is salt resistant and renin dependent, and the kidney normal. Over time, preglomerular vascular disease develops (arteriolosclerosis), associated with tubulointerstitial inflammation; this shifts the hypertension to a salt-sensitive, volume-dependent, and renal-dependent pathway. This pathway unites many of the previous hypotheses on the etiology of hypertension, and offers insights into ways to prevent, ameliorate, or cure the underlying process.