Clinical Case 69: Answers and Summary

WHILE WE HAVE BEEN "NEPHRO-CENTRIC" IN THE ROLE OF THE KIDNEY IN HYPERTENSION, WHAT OTHER ORGANS HAVE EMERGED AS POTENTIAL CONTRIBUTORS IN DEVELOPMENT OF HYPERTENSION

Given the expertise on this topic of Dr Matthew Sparks, here is his thoughts.  Basically, all the above organs are correct and have a role in hypertension. 

Novel concepts in hypertension- beyond the kidney

Hypertension is one of the most common medical disorders.  The pathogenesis of this complex disease process is multifactorial and defining precisely which organ systems are deranged continues to widen.  For many renal physiologists, Dr Arthur Guyton is seen as the patriarch of the kidney-centric view of hypertension.  Guyton articulated his power studies where he argued that the kidney plays a central role in the determination of long-term blood pressure.  Guyton suggested that the control of blood pressure and sodium balance are tightly linked.  His central tenet referred to as the pressure-natriuresis curve was elegantly described in this paper published in Science in 1991. However, over the last several decades we have witnessed how complex blood pressure regulation really is.  It is not surprising that multiple redundant systems are needed to control something as fundamental to human life as blood pressure. In the next 3 posts, I shall discuss recent advances in the understanding of hypertension from a basic science research perspective involving the skin, central nervous system, and the immune system. 

Stay tuned for role of skin, CNS and immune system in HTN in coming days. 

Matthew Sparks, MD