TY - CHAP M1 - Book, Section TI - PATHOPHYSIOLOGY OF HYPERTENSION A1 - Hall, John E. A1 - Granger, Joey P. A1 - Jones, Daniel W. A1 - Hall, Michael E. A2 - Fuster, Valentin A2 - Harrington, Robert A. A2 - Narula, Jagat A2 - Eapen, Zubin J. PY - 2017 T2 - Hurst's The Heart, 14e AB - SummaryThis chapter discusses mechanisms of physiological regulation of blood pressure (BP) and pathophysiological changes that lead to hypertension. Long-term control of BP occurs via the renal-body fluid feedback system, which involves pressure natriuresis—the high-BP-induced increase in sodium and water excretion by the kidney that leads to a reduction of the BP. Impaired pressure natriuresis can result from impaired renal function, altered activation of hormones that regulate salt and water excretion by the kidney (such as those in the renin-angiotensin-aldosterone system), or excessive activation of the sympathetic nervous system (see accompanying Hurst's Central Illustration). In hypertensive individuals, increased BP is sustained by a shift of pressure natriuresis such that a sodium balance is maintained at higher BP; therefore, effective treatment requires the resetting of pressure natriuresis toward normal BP. This resetting can be achieved by increasing renal excretory capability (for example, by using diuretics) or by reducing antinatriuretic influences on the kidney (for example, using inhibitors of the renin-angiotensin-aldosterone system). SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/11/03 UR - accessmedicine.mhmedical.com/content.aspx?aid=1191186274 ER -