به نام خدا Dominant Role of the Kidney in Long-Term Regulation of Arterial Pressure and in Hypertension: The Integrated System for Pressure Control

CONTROL OF EXTRACELLULAR FLUID VOLUME Effective circulating volume Volume sensors Kidney Adjustment to NaCl excretion

Quantitation of Pressure Diuresis as a Basis for Arterial Pressure Control

An Experiment Demonstrating the Renal–Body Fluid System for Arterial Pressure Control

Infinite Feedback Gain” Feature “ the arterial pressure rises until once again it returns exactly to the equilibrium point Infinite Feedback Gain” Feature

the two primary determinants of the long-term arterial pressure level are as follows: 1. The degree of pressure shift of the renal output curve for water and salt 2. The level of the water and salt intake line

arterial pressure = cardiac output * total peripheral resistance

increase in osmolality caused Importance of Salt (NaCl) in the Renal–Body Fluid Schema for Arterial Pressure Regulation increase in osmolality caused stimulates the thirst center in the brain stimulates the antidiuretic hormone

Hypertension

Category Systolic (mmHg) Diastolic (mmHg) Optimal Normal High normal Hypertension Stage I Stage II Stage III < 120 < 130 130-140 140-159 160-179 > 180 < 80 < 85 85-89 90-99 100-109 > 110

lethal effects of hypertension are caused mainly in three ways: 1. Excess workload on the heart leads to early heart failure and coronary heart disease, often causing death as a result of a heart attack. 2. cerebral infarct. Clinically it is called a “stroke 3 injury in the kidneys, producing many areas of renal destruction and, eventually, kidney failure, uremia, and death

Types of Hypertension Hypertension Caused by Primary Aldosteronism Hypertension Caused by a Renin-Secreting Tumor or by Infusion of Angiotensin II Hypertension in the Upper Part of the Body Caused by Coarctation of the Aorta Hypertension Caused by Diseased Kidneys That Secrete Renin Chronically Hypertension in Preeclampsia (Toxemia of Pregnancy) Neurogenic Hypertension “Primary (Essential) Hypertension”

Some of the characteristics of primary hypertension caused by excess weight gain and obesity include: Cardiac output is increased Sympathetic nerve activity, especially in the kidneys, Angiotensin II and aldosterone levels are increased two- to threefold in many obese patients The renal-pressure natriuresis mechanism is impaired

Causes of Hypertension Genetic factors Environmental factors Autonomic abnormalities Renal functional and structural abnormalities The renin-angiotenin-aldosterone system Endothelial dysfunction Other humoral-endocrine factors Insulin resistance and other metabolic factors Cardiovascular structural changes The multifactorial hypothesis