Hypertension in renal parenchymal disease: why is it so resistant to treatment?
The association between hypertension and chronic renal disease is well known. The pathogenesis of hypertension in patients with chronic kidney disease (CKD) is complex and multifactorial, which may explain why it is resistant to treatment. The traditional paradigm is that hypertension in CKD is due either to an excess of intravascular volume (volume dependent) or to excessive activation of the renin-angiotensin system in relation to the state of sodium/volume balance (renin-dependent hypertension). This review focuses on the importance of less established mechanisms, such as increased activity of the sympathetic nervous system, increased endothelin production, decreased availability of endothelium-derived vasodilators and structural changes of the arteries, renal ischemia, and sleep apnea.
Campese
V M
VM
Department of Medicine, Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. campese@usc.edu
Mitra
N
N
Sandee
D
D
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001158:Arteries / Q000473:pathology / Q000503:physiopathology; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology; D004351:Drug Resistance / Q000502:physiology; D016232:Endothelins / Q000502:physiology; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D007049:Iatrogenic Disease; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology*; D018384:Oxidative Stress / Q000502:physiology; D012084:Renin-Angiotensin System / Q000502:physiology; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology
D000959:Antihypertensive Agents; D016232:Endothelins