Are There Markers for the Physiopathology of Essential Hypertension?

  • Alberto Zanchetti


Widespread interest for the physiopathology of hypertension has undoubtedly been raised by the hope of understanding the error or the errors of regulation by which higher blood pressure values are attained, but this cognitive interest has often been coupled with the hope that improved Physiopathologic understanding might result in improved management of hypertension. This practical interest is linked with the belief that qualitatively or, at least, quantitatively different mechanisms underlie the rise in blood pressure in different patients. The hope of learning the best individual treatment for a given physiopathological profile requires a process of simplification, that is the identification of simple but meaningful indices, or markers, from which a more complex functional pattern can be described. The question mark in the title of this lecture “Are there markers for the physiopathology of essential hypertension?” has been placed to signify the uncertainty as to whether any of the markers that have been proposed and used really measures the function we assume that it measures, whether other functional variables have a fixed relation with the supposed marker and can be inferred from measurement of the latter, and finally whether useful therapeutic guidelines can be derived from its measurement.


Mean Arterial Pressure Essential Hypertension Plasma Noradrenaline Carotid Sinus Sympathetic Muscle Nerve Activity 
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  1. 1.
    A. L. Mark and R. E. Kerber, Augmentation of cardiopulmonary baroreflex control of forearm vascular resistance in borderline hypertension, Hypertension, 4:39 (1982).PubMedCrossRefGoogle Scholar
  2. 2.
    P. Sleight, Reflex control of the heart rate, Am. J. Cardiol., 44:889 (1979).PubMedCrossRefGoogle Scholar
  3. 3.
    G. Mancia, A. Ferrari, L. Gregorini, R. Valentini, J. Ludbrook and A. Zanchetti, Circulatory reflexes from carotid and extra-carotid baroreceptor areas in man, Circ. Res., 41:309 (1977).PubMedCrossRefGoogle Scholar
  4. 4.
    G. Mancia, J. Ludbrook, A. Ferrari, L. Gregorini and A. Zanchetti, Baroreceptor reflexes in human hypertension, Circ. Res., 43:170 (1978).PubMedCrossRefGoogle Scholar
  5. 5.
    A. Zanchetti, Overview of cardiovascular reflexes in hypertension, Am. J. Cardiol., 44:912 (1979).PubMedCrossRefGoogle Scholar
  6. 6.
    G. Mancia, A. Ferrari, G. Leonetti, G. Pomidossi and A. Zanchetti, Carotid sinus baroreceptor control of arterial pressure in renovascular hypertensive subjects, Hypertension, 4:47 (1982).PubMedCrossRefGoogle Scholar
  7. 7.
    M. C. Andresen, J. M. Krauhs and A. M. Brown, Relationship of aortic walls and baroreceptor properties during development in normotensive and spontaneously hypertensive rats, Circ. Res., 43:728 (1978).PubMedCrossRefGoogle Scholar
  8. 8.
    D. S. Goldstein, Plasma norepinephrine in essential hypertension. A study of the studies, Hypertension, 3:48 (1981).PubMedCrossRefGoogle Scholar
  9. 9.
    G. Mancia, G. Leonetti, G. B. Picotti, A. Ferrari, M. D. Galva, L. Gregorini, G. Parati, G. Pomidossi, C. Ravazzani, C. Sala and A. Zanchetti, Plasma catecholamines and blood pressure responses to the carotid baroreceptor reflex in essential hypertension, Clin. Sci., 57, Suppl. 5:156 (1979).Google Scholar
  10. 10.
    B. G. Wallin, G. Sundlöf, B. M. Eriksson, P. Dominiak, H. Gro-becker and L. E. Lindblad, Plasma noradrenaline correlates to sympathetic muscle nerve activity in normotensive man, Acta Physiol. Scand., 111:69 (1981).PubMedCrossRefGoogle Scholar
  11. 11.
    J. Brod, Essential hypertension. Haemodynamic observations with a bearing on its pathogenesis, Lancet, 1:733 (1960).Google Scholar
  12. 12.
    R. Franco-Morselli, J. L. Elghozi, E. Joly, S. Di Giulio and P. Meyer, Increased plasma adrenaline concentrations in benign essential hypertension, Brit. Med. J., 2:1251 (1977).PubMedCrossRefGoogle Scholar
  13. 13.
    O. Bertel, F. R. Bühler, W. Kiowski and B. E. Lütold, Decreased beta-adrenoceptor responsiveness as related to age, blood pressure and plasma catecholamines in patients with essential hypertension, Hypertension, 2:130 (1980).PubMedCrossRefGoogle Scholar
  14. 14.
    L. H. Tung, M. J. Rand and H. Majewski, Adrenaline-induced hypertension in rats, Clin. Sci., 61, Suppl. 7:191 (1981).Google Scholar
  15. 15.
    D. C. Tosteson, N. Adragna, I. Bize, H. Solomon and M. Canessa, Membranes, ions and hypertension, Clin. Sci., 61, Suppl. 7:5 (1981).Google Scholar
  16. 16.
    Y. Postnov and S. Orlov, Alterations of cell membranes in primary hypertension, Proc. IX World Congress of Cardiology, in press.Google Scholar
  17. 17.
    F. Wessels, G. Junge-Hulsing and H. Losse, Untersuchungen zur Natriumpermeabilität der Erythrozyten bei Hypertonikern und Normotonikern mit familiärer Hochdruckbelastung, Z. Kreislauf-forsch., 56:374 (1967).Google Scholar
  18. 18.
    Y. Postnov, S. Orlov, A. Shevchenko and A. Adler, Altered sodium permeability, calcium binding and Na+, K+-ATPase activity in the red blood cell membrane in essential hypertension, Pflügers Arch., 371:263 (1977).PubMedCrossRefGoogle Scholar
  19. 19.
    R. P. Garay and P. Meyer, A new test showing abnormal net Na+ and K+ fluxes in erythrocytes of essential hypertensive patients, Lancet, 1:349 (1979).PubMedCrossRefGoogle Scholar
  20. 20.
    M. Canessa, M. Adragna, H. S. Solomon, T. M. Connolly and D. C. Tosteson, Increased sodium, lithium countertransport in red cells of patients with essential hypertension, New Engl. J. Med., 302:772 (1980).PubMedCrossRefGoogle Scholar
  21. 21.
    R. P. S. Edmonsom, R. D. Thomas, P. J. Hilton, J. Patrick and N. F. Jones, Abnormal leucocyte composition and sodium transport in essential hypertension, Lancet, 1:1003 (1975).Google Scholar
  22. 22.
    E. Ambrosioni, L. Tartagni, L. Montebugnoli and B. Magnani, Intralymphocytic sodium in hypertensive patients: a significant correlation, Clin. Sci., 57, Suppl. 5:325 (1979).Google Scholar
  23. 23.
    R. P. Garay, G. Dagher, M. G. Pernollet, M. A. Devynck and P. Meyer, Inherited defect in Na+, K+ co-transport system in erythrocytes from essential hypertensive patients, Nature, 284:281 (1980).PubMedCrossRefGoogle Scholar
  24. 24.
    R. P. Garay, J. L. Elghozi, G. Dagher and P. Meyer, Laboratory distinction between essential and secondary hypertension by measurement of erythrocyte cation fluxes, New Engl. J. Med., 382:769 (1980).CrossRefGoogle Scholar
  25. 25.
    M. Canali, L. Borghi, E. Sani, A. Curti, A. Montanari, A. Novarini and A. Borghetti, Increased erythrocyte lithium-sodium countertransport in essential hypertension: its relationship to family history of hypertension, Clin. Sci., 61, Suppl. 7:13 (1981).Google Scholar
  26. 26.
    D. Cusi, C. Barlassina, M. Ferrandi, P. Palazzi, E. Celega and G. Bianchi, Relationship between altered Na+-K+ co-transport and Na+-Li+ countertransport in the erythrocytes of essential hypertensive patients, Clin. Sci., 61, Suppl. 7:33 (1981).Google Scholar
  27. 27.
    H. E. de Wardener and G. A. MacGregor, Dahl’s hypothesis that a saluretic substance may be responsible for a sustained rise in arterial pressure: its possible role in essential hypertension, Kidney Intern., 18:1 (1980).CrossRefGoogle Scholar
  28. 28.
    J. H. Laragh, Vasoconstriction-volume analysis for understanding and treating hypertension. The use of renin and aldosterone profiles, Am. J. Med., 55:261 (1973).PubMedCrossRefGoogle Scholar
  29. 29.
    P. L. Padfield, D. G. Beevers, J. J. Brown, D. L. Davies, R. Fraser, A. F. Lever, J. I. S. Robertson, M. A. D. H. Schalekamp, G. Kolsters and W. H. Birkenhäger, Low renin hypertension: a diagnostic entity attributable to mineralocorticoid excess?, in: “Hypertension — its nature and treatment”, D. M. Burley, G. F. B. Birwood, J. M. Fryer, S. H. Taylor, eds., p. 135, Ciba, Horsham (1975).Google Scholar
  30. 30.
    A. Zanchetti, A. Stella, G. Leonetti, A. Morganti and L. Terzoli, Control of renin release: experimental evidence and clinical implications, in: “Topics in hypertension”, J. H. Laragh, ed., chapter 7, Yorke Medical Books, New York (1980).Google Scholar
  31. 31.
    C. Beretta-Piccoli, D. L. Davies, K. Boddy, J. J. Brown, A. M. M. Cumming, B. W. East, R. Fraser, A. F. Lever, P. L. Padfield, P. F. Semple, J. I. S. Robertson, P. Weidmann and E. D. Williams, Relation of arterial pressure with body sodium, body potassium and plasma potassium in essential hypertension, Clin. Sci., 63:257 (1982).PubMedGoogle Scholar
  32. 32.
    F. R. Bühler, J. H. Laragh, E. D. Vaughan Jr., H. R. Brunner, H. Gavras and L. Baer, Antihypertensive action of propranolol. Specific antirenin responses in high and normal renin forms of essential, renal, renovascular and malignant hypertension, Am. J. Cardiol., 32:511 (1973).PubMedCrossRefGoogle Scholar
  33. 33.
    A. Zanchetti, G. Leonetti, L. Terzoli and C. Sala, Beta-blockers and renin, in: “Beta Blockade in the 1980s”, in publication.Google Scholar
  34. 34.
    E. D. Freis, Salt, volume and the prevention of hypertension, Circulation, 53:589 (1979).CrossRefGoogle Scholar
  35. 35.
    A. Zanchetti, Essential hypertension today and tomorrow, in: “Blood pressure measurement and systemic hypertension”, A. C. Arntzenius, A. J. Dunning, H. A. Snellen, eds., p. 261, Medical World Press, Breda (1981).Google Scholar

Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • Alberto Zanchetti
    • 1
  1. 1.Istituto di Clinica Medica IVUniversità di Milano, and Centro di Fisiologia Clinica e Ipertensione, Ospedale Maggiore, C.N.R.MilanItaly

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