open access

Vol 15, No 6 (2011)
REVIEV
Published online: 2012-02-23
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The role of renin–angiotensin–aldosterone system in etiology and pathogenesis of arterial hypertension and its systemic complications — what remains from Laragh and Alderman idea?

Tomasz Pizoń, Marek Rajzer, Tomasz Kameczura
Nadciśnienie tętnicze 2011;15(6):371-382.

open access

Vol 15, No 6 (2011)
REVIEV
Published online: 2012-02-23

Abstract

The history of research on kidney role in arterial hypertension begins in 1892 when Brown-Sequard suggested internal secretion of kidneys that causes hypertension.
Since then we observe dynamic development of laboratory assessments that allowed to discover and understand activity of renin–angiotensin–aldosterone system. This system works as a feedback mechanism and plays the key role in regulation of blood pressure (BP) by angiotensin secretion and sodium-volume status by aldosterone release. Laragh and Alderman assume that cardiac output CO) is determined by sodium-volume factor while vasoconstriction (total peripheral resistance — TPR) results from plasma renin-angiotensin concentration. (BP) = CO × TPR. Using plasma renin activity (PRA) value it is possible to divide all hypertensive patients into two basic subtypes. PRA > 0.65 ng/ml/h is connected with the renin–angiotensin mediated vasoconstrictor hypertension („R” hypertension) and PRA < 0.65 ng/ml/h is connected with sodium-volume mediated hypertension („V” hypertension). „R” hypertension is diagnosed in 60–70% of hypertensive patients and „V” hypertension in 30–40%. Different mechanisms of antihypertensive drugs action determine usefulness of them in a given type of hypertension. ACEIs, ARBs and beta-blockers represent „R” drugs that block plasma renin system. Diuretics, calcium channel blockers and alpha-blockers belong to „V” drugs that reduce sodium-volume component. Laragh and Alderman, two eminent scientists and practitioners, show us that giving proper „R” or „V” drug it is possible to achieve therapeutic goals with just a monotherapy. In this article we try to analyse if such simple pathophysiological hypothesis of arterial hypertension should be still implemented in everyday clinical practice.

Abstract

The history of research on kidney role in arterial hypertension begins in 1892 when Brown-Sequard suggested internal secretion of kidneys that causes hypertension.
Since then we observe dynamic development of laboratory assessments that allowed to discover and understand activity of renin–angiotensin–aldosterone system. This system works as a feedback mechanism and plays the key role in regulation of blood pressure (BP) by angiotensin secretion and sodium-volume status by aldosterone release. Laragh and Alderman assume that cardiac output CO) is determined by sodium-volume factor while vasoconstriction (total peripheral resistance — TPR) results from plasma renin-angiotensin concentration. (BP) = CO × TPR. Using plasma renin activity (PRA) value it is possible to divide all hypertensive patients into two basic subtypes. PRA > 0.65 ng/ml/h is connected with the renin–angiotensin mediated vasoconstrictor hypertension („R” hypertension) and PRA < 0.65 ng/ml/h is connected with sodium-volume mediated hypertension („V” hypertension). „R” hypertension is diagnosed in 60–70% of hypertensive patients and „V” hypertension in 30–40%. Different mechanisms of antihypertensive drugs action determine usefulness of them in a given type of hypertension. ACEIs, ARBs and beta-blockers represent „R” drugs that block plasma renin system. Diuretics, calcium channel blockers and alpha-blockers belong to „V” drugs that reduce sodium-volume component. Laragh and Alderman, two eminent scientists and practitioners, show us that giving proper „R” or „V” drug it is possible to achieve therapeutic goals with just a monotherapy. In this article we try to analyse if such simple pathophysiological hypothesis of arterial hypertension should be still implemented in everyday clinical practice.
Get Citation

Keywords

arterial hypertension; „R” hypertension; „V” hypertension

About this article
Title

The role of renin–angiotensin–aldosterone system in etiology and pathogenesis of arterial hypertension and its systemic complications — what remains from Laragh and Alderman idea?

Journal

Arterial Hypertension

Issue

Vol 15, No 6 (2011)

Pages

371-382

Published online

2012-02-23

Bibliographic record

Nadciśnienie tętnicze 2011;15(6):371-382.

Keywords

arterial hypertension
„R” hypertension
„V” hypertension

Authors

Tomasz Pizoń
Marek Rajzer
Tomasz Kameczura

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