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Pathogenesis of Hypertension in Blacks: Features of an Equilibrium Model

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Pathophysiology of Hypertension in Blacks

Part of the book series: Clinical Physiology Series ((CLINPHY))

Abstract

The mosaic theory continues to command the center of hypertension research. Burton (40) was the first to show that any theory for control of blood pressure must rest on some fundamental principles of equilibrium of the arterioles. Page (176) subsequently argued that the problem of hypertension may be “more realistically soluble in terms of altered equilibria than by any one of a variety of monistic approaches.” He later brought the theory to bear on renal hypertension (175,177), the center being the physical equilibrium of the arteriole, with factors such as genetic, environmental, anatomical, adaptive, neural, endocrine, humoral, and hemodynamic forming the margin. Thus, most theoretical discourse focuses on renal hypertension, because it has been acknowledged that the pathogenesis is very similar to human essential hypertension (18). The purpose of this chapter is to review the conceptual understanding of the problem of hypertension in general, taking renal hypertension as a marginal model for the pathogenesis of the disease in blacks.

At its inception, the mosaic theory was portrayed as an octagon with the then known regulators on each focal point and arrows indicating a closed system in equilibrium…. [genetic, environmental, anatomical, adaptive, neural, endocrine, humoral, hemodynamic]. Clearly, this… is not meant to list all of the multiple mechanisms currently adumbrated as constituting the many facets of hypertension considered as a “disease of regulation.” Rather, the mosaic concept is intended to provide a logical and orderly way of thinking about all forms of hypertension as a subject for research and as a means of analyzing the problem in patients.

I. H. Page

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  1. Department of Physiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA

    John C. S. Fray

  2. Division of Endocrinology and Hypertension, Case Western Reserve University, Cleveland, Ohio, USA

    Janice G. Douglas

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Fray, J.C.S. (1993). Pathogenesis of Hypertension in Blacks: Features of an Equilibrium Model. In: Fray, J.C.S., Douglas, J.G. (eds) Pathophysiology of Hypertension in Blacks. Clinical Physiology Series. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7577-4_11

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