Is Hypertension a Bone Marrow Disease?
Hypertension affects 30% of the population and 70% of the elderly. Despite its frequency and decades of research, the etiology of most cases of adult hypertension remains undefined. Perturbations of the kidney, the vasculature and the central nervous system have all been implicated in the pathogenesis of hypertension. As examples, in most cases of adult hypertension, systemic vascular resistance is elevated and vasodilators lower blood pressure, supporting a vascular etiology. Alternatively, renal cross-transplantation studies have shown that hypertension follows the kidney and in most cases of experimental hypertension, pressure natriuresis is impaired. Likewise, most single gene mutations that cause hypertension affect sodium transport in the distal nephron. In keeping with a renal etiology, diuretics and sodium restriction are effective in lowering blood pressure. Finally, there is ample evidence to suggest a central-neural cause of hypertension. Sympathetic outflow is almost uniformly increased in experimental models of hypertension and in humans with this disease and renal denervation has been variably reported to reduce blood pressure. Adrenergic receptor antagonists are commonly used to treat hypertension, further supporting a neural etiology.
- Received August 26, 2016.
- Accepted September 2, 2016.