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May 22, 1996, Vol 275, No. 20 >
ARTICLE | May 22, 1996

The Role of the Kidney in Hypertension FREE

Allen W. Cowley, Jr, PhD; Richard J. Roman, PhD
[+] Author Affiliations

Reprints: Allen W. Cowley, Jr, MD, Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, Wl 53226.


JAMA. 1996;275(20):1581-1589. doi:10.1001/jama.1996.03530440061038
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References

DESPITE unequivocal evidence that renal function is altered in hypertension, certain important issues are unresolved. The most controversial area is whether the observed changes in renal function are a consequence of hypertension or the primary basis of the disease. Although there is little doubt that the kidney is progressively damaged as a longterm consequence of hypertension, 6 lines of evidence indicate that renal function is altered before the development of the disease and that some form of renal dysfunction is essential for the development and maintenance of hypertension.

These studies demonstrate that (1) the kidney plays a dominant role in the long-term control of blood pressure; (2) the induction of every experimental model of hypertension involves some maneuver that reduces renal excretory function, and certain changes, such as reduction of renal medullary blood flow, can be observed before the development of hypertension and in the absence of more global changes

REFERENCES

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2 +
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4 +
Tobian L, Lange J, Azar S, et al.  Reduction of natriuretic capacity and renin release in isolated blood-perfused kidneys of Dahl hypertension-prone rats. Circ Res . 1978;;43( (suppl I) ):I-92-I-98.
5 +
Roman RJ, Cowley AW Jr.  Characterization of a new model for the study of pressure-natriuresis in the rat. Am J Physiol . 1985;a;248:F190-F198.
6 +
Roman RJ, Cowley AW Jr, Garcia-Estan J, Lombard JH.  Pressure-diuresis in volume-expanded rats: cortical and medullary hemodynamics. Hypertension . 1988;f;12:168-176.
7 +
Farrugia E, Lockhart JC, Larson TS.  Relationships between vasa recta blood flow and renal interstitial hydrostatic pressure during pressure natriuresis. Circ Res . 1993;;71:1153-1158.
8 +
Mattson DL, Raff H, Roman RJ.  Influence of angiotensin II on pressure-natriuresis and renal hemodynamics in volume-expanded rats. Am J Physiol . 1991;;260:R1200-R1209.
9 +
Huang C, Davis G, Johns EJ.  Effect of nitrendipine on autoregulation of perfusion in the cortex and papilla of kidneys from Wistar and stroke-prone spontaneously hypertensive rats. Br J Pharmacol . 1994;;111:111-116.
10 +
Strick DM, Ficksen-Olsen MJ, Lockhart JC, Roman RJ, Romero JC.  Direct measurement of renal medullary blood flow in the dog. Am J Physiol . 1994;;257:R253-R259.
11 +
Lerman LO, Bentley MD, Fixsen-Olsen MJ, Strick DM, Rittman EL, Romero JC.  Pressure dependency of canine intrarenal blood flow within the range of blood flow autoregulation. Am J Physiol . 1995;;268:F404-F409.
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Kinoshita Y, Knox FG.  Role of prostaglandins in proximal tubule sodium reabsorption: response to elevated renal interstitial hydrostatic pressure. Circ Res . 1989;;64:1013-1018.
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Roman RJ, Zou AP.  Influence of the renal medullary circulation on the control of sodium excretion. Am J Physiol . 1993;;265:R963-R973.
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Guyton AC, Coleman TG, Cowley AW Jr, Scheel KW, Manning RD Jr, Norman RA Jr.  Arterial pressure regulation: overriding dominance of the kidneys in long-term regulation and in hypertension. Am J Med . 1972;;52:584-594.
2 +
Guyton AC, Coleman TG, Cowley AW Jr, Manning RD Jr, Norman RA Jr.  A systems analysis approach to understanding long-range arterial blood pressure control and hypertension. Circ Res . 1974;; 35:159-176.
3 +
Aperia AC, Brobergen CGO, Sodenland S.  Relationship between renal artery perfusion pressure and tubular reabsorption. Am J Physiol . 1971;;220: 1205-1212.
4 +
Tobian L, Lange J, Azar S, et al.  Reduction of natriuretic capacity and renin release in isolated blood-perfused kidneys of Dahl hypertension-prone rats. Circ Res . 1978;;43( (suppl I) ):I-92-I-98.
5 +
Roman RJ, Cowley AW Jr.  Characterization of a new model for the study of pressure-natriuresis in the rat. Am J Physiol . 1985;a;248:F190-F198.
6 +
Roman RJ, Cowley AW Jr, Garcia-Estan J, Lombard JH.  Pressure-diuresis in volume-expanded rats: cortical and medullary hemodynamics. Hypertension . 1988;f;12:168-176.
7 +
Farrugia E, Lockhart JC, Larson TS.  Relationships between vasa recta blood flow and renal interstitial hydrostatic pressure during pressure natriuresis. Circ Res . 1993;;71:1153-1158.
8 +
Mattson DL, Raff H, Roman RJ.  Influence of angiotensin II on pressure-natriuresis and renal hemodynamics in volume-expanded rats. Am J Physiol . 1991;;260:R1200-R1209.
9 +
Huang C, Davis G, Johns EJ.  Effect of nitrendipine on autoregulation of perfusion in the cortex and papilla of kidneys from Wistar and stroke-prone spontaneously hypertensive rats. Br J Pharmacol . 1994;;111:111-116.
10 +
Strick DM, Ficksen-Olsen MJ, Lockhart JC, Roman RJ, Romero JC.  Direct measurement of renal medullary blood flow in the dog. Am J Physiol . 1994;;257:R253-R259.
11 +
Lerman LO, Bentley MD, Fixsen-Olsen MJ, Strick DM, Rittman EL, Romero JC.  Pressure dependency of canine intrarenal blood flow within the range of blood flow autoregulation. Am J Physiol . 1995;;268:F404-F409.
12 +
Roman RJ.  Pressure-diuresis in volume-expanded rats: tubular reabsorption in superficial and deep nephrons. Hypertension . 1988;e;12:177-183.
13 +
Haas JA, Granger JP, Knox FG.  Effect of renal perfusion pressure on sodium reabsorption from proximal tubules of superficial and deep nephrons. Am J Physiol . 1986;;250:F425-F429.
14 +
Kinoshita Y, Knox FG.  Role of prostaglandins in proximal tubule sodium reabsorption: response to elevated renal interstitial hydrostatic pressure. Circ Res . 1989;;64:1013-1018.
15 +
Roman RJ, Zou AP.  Influence of the renal medullary circulation on the control of sodium excretion. Am J Physiol . 1993;;265:R963-R973.
16 +
Brand PH, Coyne KB, Kostrzewski KA, Shier D, Metting PJ, Britton SL.  Pressure diuresis and autonomic function in conscious dogs. Am J Physiol . 1991;;261:R802-R810.
17 +
Ehmke H, Persson PB, Seyforth M, Kirchheim HR.  Neurogenic control of pressure natriuresis in conscious dogs. Am J Physiol . 1990;;259:F466-F473.
18 +
Dunn MJ, Hood VL.  Prostaglandins and the kidney. Am J Physiol . 1977;:233:F169-F184.
19 +
Roman RJ, Lianos E.  Influence of renal prostaglandins on papillary blood flow, renal interstitial pressure and pressure-natriuretic response. Hypertension . 1990;;15:29-35.
20 +
Roman RJ, Kauker ML.  Renal effect of prostaglandin synthetase inhibition in rats: micropuncture studies. Am J Physiol . 1978;;235:F111-F118.
21 +
Higashihara E, Stokes JB, Kokko JP, Campbell WB, DuBose TD.  Cortical and papillary micropuncture examination of chloride transport in segments of the rat kidney during inhibition of prostaglandin production. J Clin Invest . 1979;;64:1277-1287.
22 +
Pawlowska D, Haas JA, Granter JP, Romero JC, Knox FG.  Prostaglandin blockade blunts the natriuresis of elevated renal interstitial hydrostatic pressure. Am J Physiol . 1988;;254:F507-F511.
23 +
Gonzales-CompoyJM, Long C, Robert D, Berndt TJ, Romero C, Knox FG.  Renal interstitial hydrostatic pressure and PGI2 in pressure-natriuresis. Am J Physiol . 1991;;260:F643-F649.
24 +
Faubert PF, Chou SY, Porush HG.  Regulation of papillary plasma flow by angiotensin II. Kidney Int . 1987;;32:472-478.
25 +
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26 +
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