Urologic Causes of Hypertension

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CONCEPTS OF HYPERTENSION have undergone significant changes during the past fifty years. The early concept that hypertension was the result of a defective arterial circulation and that to lower blood pressure would be detrimental to life was slowly replaced by a recognition that high blood pressure plays an important role in the maintenance and/or progression of hypertensive vascular disease. Much of the advance in the understanding of clinical hypertension is based upon studies of experimental hypertension. Twenty years ago, hypertension was first produced in animals by (1) section of the sino-aortic depressor nerves (Koch and Mies), (2) constriction of the renal artery (Goldblatt), and (3) production of perinephritis (Page). Subsequently, experimental endocrine hypertension was elicited in rats (Selye) and the hypertension of coarctation of the aorta experimentally reproduced in dogs, although participation of renal mechanisms in the latter has not yet been fully defined.

Hypertension is now looked upon as but one manifestation of a systemic disease. Clinically, the course varies from a relatively benign state, in which the only abnormality is elevated blood pressure to a fulminant process, with widespread arteriolar necrosis. Two broad etiologic categories of hypertensive diseaes are recognized. These are: (1) primary or essential hypertension, for which no single cause is demonstrable; it probably has a genetic basis and includes conditions, such as the hypertensive diencephalic syndrome, which may have specific etiologies; (2) the secondary hypertensions; these have recognizable causes, although the pressor mechanisms may not yet be fully understood.

In most patients, the diagnosis of. . .



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