Kidney and Hypertension—Causes

Renal disease is closely associated with hypertension. On the one hand, kidney disease provokes hypertension. On the other hand, hypertension aggravates the progression of renal dysfunction. The pathomechanisms through which the kidney raises blood pressure have been considerably clarified in recent years. In experimental and clinical studies, it could be shown that "hypertension goes with the kidney". This suggests that some renal anomalies predispose to hypertension. Recently, it could be shown that the kidneys of individuals with so-called essential hypertension have less glomeruli than the kidneys of control individuals. In renal patients the kidney raises blood pressure through several mechanisms. First, the pressure-natriuresis relationship is shifted to the right, i. e., sodium excretion requires higher renal perfusion pressures. Second, there is inappropriate activation of the renin-angiotensin system. Third, as only recently documented in detail, renal injury raises the sympathetic tone, even when whole kidney glomerular filtration rate (GFR) is unchanged. This results from stimulating afferent signals emanating from the kidney. Fourth, there is evidence of impaired endothelial cell dependent vasodilatation even in very early stages of renal dysfunction. Fifth, the pulse pressure profile is altered as a consequence of premature and accelerated aging causing stiffening of the aorta. Knowledge of these pathomechanisms is important for selection of appropriate antihypertensive treatment.     

Lifestyle and Hypertension—An Overview

Dietary and other life style factors play a major role in the prevalence of hypertension. Many of the behaviours likely to reduce blood pressure also have independent beneficial effects on other cardiovascular risk tactors to general health and survival. This is particularly the case with weight control, exercise, dietary patterns characterised by a low intake of saturated fat and a high intake of fruit, vegetables and fish and moderation of heavy alcohol consumption. High salt intakes remain a major contributor to hypertension, especially when potassium intake is low. Smoking has a dominant effect in increasing cardiovascular risk in hypertensives. Clustering of risk factors is often associated with clustering of unhealthy lifestyle characteristics and both are most prominent in lower socio-economic groups and in Developing Countries adopting a more sedentary lifestyle and Western diet patterns. Recent trials suggest substantial cardiovascular benefits by a combination of weight control and sodium moderation in the elderly, by non-vegetarian diets rich in fruit and vegetables and low in saturated fat, and by incorporation of regular fish meals into weight control diets.     

Hypertension Prevalence in Liaoning Province, 1991

利用全国1991年高血压抽样调查辽宁省资料，对辽宁省高血压患病率进行分析。采用整群抽样方法，全省共调查33376人，应答率90．3，全省确诊高血压患病率7．91％；临界加确诊高血压患病率为14．94％，均较1979～1980年患病率水平为高。男性患病率高于女性（表现在较年轻组）；城市人口患病率高于农村人口（表现在35岁以上各年龄组）。     

Can hypertension be prevented? The Danish Hypertension Prevention Project and the Trial of Prevention of Hypertension studies

Essential hypertension, a major health problem worldwide, is a disease generally considered to require life-long treatment. However, evidence suggests that hypertension is caused by specific phenotypic changes caused by the combination of genetic and environmental factors. Thus, in principle, hypertension could be prevented by prevention of these phenotypic changes. Animal data indicate that early treatment that blocks the renin-angiotensin system have long-term effects after treatment withdrawal. Here we report on two human trials that are testing whether early treatment (with the AT1-antagonist, candesartan) is able to have a persistent effect after stopping treatment: the Danish Hypertension Prevention Project and Trial of Prevention of Hypertension.     

Pediatric Hypertension: Are Pediatricians Following Guidelines?

The National Heart, Lung, and Blood Institute recommends that children older than 3 years seen in the medical setting have their blood pressure (BP) measured. The authors aimed to determine whether BPs are measured at well‐child visits and whether elevated readings are recognized. A retrospective chart review of 3‐ to 18‐year‐old children seen for well‐child visits was performed. Age, sex, weight, height, BP, extremity measured, and type of intervention were collected. BP was measured in 777 of 805 patients (97%). BP was elevated in 158 patients (20%). A total of 95 patients (60%) did not receive any intervention. Not recognizing elevated BP was associated with increased daily patient load (17.9±6.5 vs 12.6±5.5, P=.001). Higher body mass index was associated with elevated BP (P=.0008) but was not associated with improved recognition. Findings show that BP is almost always measured at well‐child visits but is not being measured appropriately, and general pediatric clinics are not consistently following BP management recommendations.