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Cardiology pp 319-326 | Cite as

Renovascular Hypertension: New Aspects of Pathogenesis and Treatment

  • J. J. Brown
  • W. B. Brown
  • G. P. Hodsman
  • A. G. Lever
  • Dorothea McAreavey
  • J. J. Morton
  • Elizabeth C. M. Wallace
  • J. I. S. Robertson

Abstract

Although it is now nearly half a century since Goldblatt and his colleagues demonstrated that hypertension could be produced experimentally by the application of a constriction to a renal artery,1 the pathogenesis of this condition remains imperfectly understood. The issue is clinically relevant, because in man hypertension is often associated with renal artery stenosis, and in a proportion of such patients, although by no means all, blood pressure can be lowered either by renal arterial reconstruction or by excision of the kidney distal to the stenosis. The importance of the renin-angiotensin system in initiating and maintaining renovascular hypertension remains particularly controversial.

Keywords

Renal Artery Plasma Renin Renal Artery Stenosis Renovascular Hypertension Exchangeable Sodium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    H. Goldblatt, J. Lynch, R. Hanzal, and W. W. Sunmerville, Studies on experimental hypertension. I. The production of persistent elevation of systolic blood pressure by means of renal ischemia, J.Exp.Med. 59:347 (1934).PubMedCrossRefGoogle Scholar
  2. 2.
    J. J. Brown, V. Cuesta, D. L. Davies, A. F. Lever, J. J. Morton, P. L. Padfield, J. I. S. Robertson and P. Trust, Mechanism of renal hypertension, Lancet i:1219 (1974).Google Scholar
  3. 3.
    J. J. Morton and E. C. H. Wallace, Changes in blood pressure, renin and angiotensin II in the two-kidney one-clip Goldblatt rat: the importance of angiotensin II in the development and maintenance of hypertension. Submitted for publication. (1982).Google Scholar
  4. 4.
    A. M. Caravaggi, G. Bianchi, J. J. Brown, A. F. Lever, J. J. Morton, J. D. Powell-Jackson, J. I. S. Robertson, and P. F. Semple, Blood pressure and plasma angiotensin II concentration after renal artery constriction and angiotensin II infusion in the conscious dog, Circ.Res. 38:315 (1976).PubMedCrossRefGoogle Scholar
  5. 5.
    J. J. Brown, J. Casals-Stenzel, A. M. M. Cumming, D. L. Davies, R. Fraser, A. F. Lever, J. J. Morton, P. F. Semple, M. Tree, and J. I. S. Robertson, Angiotensin II, aldosterone and arterial pressure: a quantitative approach, Hypertension 1:159 (1979).PubMedCrossRefGoogle Scholar
  6. 6.
    J. J. Brown, R. Fraser, A. F. Lever, J. J. Morton, J. I. S. Robertson, M. Tree, P. R. F. Bell, J. K. Davidson, and I. S. Ruthven, Hypertension and secondary hyperaldosteronism associated with a renin-secreting renal juxtaglomerular cell tumour, Lancet ii:1228 (1973).CrossRefGoogle Scholar
  7. 7.
    B. L. Bean, J. J. Brown, J. Casals-Stenzel, R. Fraser, A. F. Lever, J. A. Millar, J. J. Morton, B. Petch, G. Riegger, J. I. S. Robertson, and M. Tree, Relation of arterial pressure and plasma angiotensin II concentration: a change produced by prolonged infusion of angiotensin II in the dog, Circ.Res. 44:452 (1979).PubMedCrossRefGoogle Scholar
  8. 8.
    B. Folkow, Cardiovascular structural adaptation: its role in the initiation and maintenance of primary hypertension, Clin.Sci. 55 (Suppl.4): 3 (1978).Google Scholar
  9. 9.
    A. W. Cowley and J. W. DeClue, Quantification of baroreceptor influence on arterial pressure changes seen in primary angiotensin-induced hypertension in dogs, Circ.Res. 39:779 (1976).PubMedCrossRefGoogle Scholar
  10. 10.
    K. L. Barnes, K. B. Brosnihan, and C. M. Ferrario, Animal models, hypertension and central nervous system mechanisms, Mayo Clin.Proc. 52:387 (1977).PubMedGoogle Scholar
  11. 11.
    A. Zanchetti and C. Bartorelli, Central nervous mechanisms in arterial hypertension: experimental and clinical evidence, in: “Hypertension,” J. Genest, E. Koiw, and O. Kuchel, eds., New York. McGraw-Hill. p.59. (1977).Google Scholar
  12. 12.
    W. Oelkers, M. Schöneshofer, G. Schultze, J. J. Brown, R. Fraser, J. J. Morton, A. F. Lever, and J. I. S. Robertson, Effect of prolonged low-dose angiotensin II on the sensitivity of the adrenal cortex in man, Circ.Res. 36, 37 (Supp1.1):49 (1975).PubMedCrossRefGoogle Scholar
  13. 13.
    D. G. Beevers, J. J. Brown, R. Fraser, A. F. Lever, J. J. Morton, J. I. S. Robertson, P. F. Semple, and M. Tree, The clinical value of renin and angiotensin estimations, Kidney Internatl. 8 (Suppl.5):181 (1975).Google Scholar
  14. 14.
    A. C. Guyton, T. G. Coleman, A. W. Cowley, K. W. Scheel, R. D. Manning, and R. A. Norman, Arterial pressure regulation: overriding dominance of the kidneys in long-term regulation and in hypertension, Am.J.Med. 52:584 (1972).PubMedCrossRefGoogle Scholar
  15. 15.
    B. E. Watkins, J. O. Davis, R. H. Freeman, and G. A. Stephens, Production of renal hypertension in adrenalectomised dogs on constant hormone replacement therapy, Proc.Soc.Exp.Biol.Med. 157:116 (1978).PubMedGoogle Scholar
  16. 16.
    J. Lucas and M. A. Floyer, Changes in body fluid distribution and interstitial compliance during the development and reversal of experimental renal hypertension in the rat, Clin.Sci. 47:1 (1974).Google Scholar
  17. 17.
    D. McAreavey, W. Brown, and J. I. S. Robertson, Exchangeable sodium in rats with Goldblatt two-kidney one-clip hypertension, Clin.Sci. (in press). (1982).Google Scholar
  18. 18.
    D. L. Davies, K. McElroy, A. B. Atkinson, J. J. Brown, A. M. M. Cumming, R. Fraser, B. J. Leckie, A. Mackay, J. J. Morton, and J. I. S. Robertson, Relationship between exchangeable sodium and blood pressure in different forms of hypertension in man, Clin.Sci. 57 (Suppl.5) :69 (1979).Google Scholar
  19. 19.
    A. B. Atkinson, J. J. Brown, D. L. Davies, A. F. Lever, J. J. Morton, R. Fraser, and J. I. S. Robertson, Hyponatraemic hypertensive syndrome with renal artery occlusion corrected by captopril, Lancet ii:606 (1979).CrossRefGoogle Scholar
  20. 20.
    J. J. Brown, W. C. B. Brown, R. Fraser, A. F. Lever, J. J. Morton, J. I. S. Robertson, E. A. Rosei, and P. M. Trust, The effects of the angiotensin II antagonist saralasin on blood pressure and plasma aldosterone in man in relation to the prevailing plasma angiotensin II concentration, Prog.Biochem.Pharmacol. 12:230 (1976).PubMedGoogle Scholar
  21. 21.
    A. G. Atkinson, J. J. Morton, J. J. Brown, A. F. Lever, R. Fraser, and J. I. S. Robertson, Captopril in clinical hypertension: changes in components of the renin-angiotensin system and in body composition in relation to the fall in blood pressure, Brit.Ht.J. 44:290 (1980).Google Scholar
  22. 22.
    A. J. G. Riegger, A. F. Lever, J. A. Millar, J. J. Morton, and B. Slack, Correction of renal hypertension in the rat by prolonged infusion of angiotensin inhibitors, Lancet ii:1317 (1977).CrossRefGoogle Scholar
  23. 23.
    A. B. Atkinson, J. J. Brown, A. M. M. Cumming, R. Fraser, A. F. Lever, B. J. Leckie, J. J. Morton, and J. I. S. Robertson, Captopril in renovascular hypertension: long-term use in predicting surgical outcome, Brit.Med.J. 284:689 and 1557 (1982).CrossRefGoogle Scholar
  24. 24.
    P. Hodsman, J. J. Brown, D. L. Davies, R. Fraser, A. F. Lever, J. J. Morton, G. D. Murray, and J. I. S. Robertson, The converting enzyme inhibitor enalapril (MK421) in the treatment of hypertension with renal artery stenosis. Submitted for publication. (1982).Google Scholar
  25. 25.
    J. J. Brown, A. F. Lever, and J. I. S. Robertson, Renal hypertension: diagnosis and treatment. In: Renal Disease, 4th edition. Edited by Sir Douglas Black and N. F. Jones, p.731 (1979).Google Scholar

Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • J. J. Brown
    • 1
  • W. B. Brown
    • 1
  • G. P. Hodsman
    • 1
  • A. G. Lever
    • 1
  • Dorothea McAreavey
    • 1
  • J. J. Morton
    • 1
  • Elizabeth C. M. Wallace
    • 1
  • J. I. S. Robertson
    • 1
  1. 1.Medical Research Council Blood Pressure UnitWestern InfirmaryGlasgowUK

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