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2014 ; 64
(4
): 801-7
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English Wikipedia
Critical blood pressure threshold dependence of hypertensive injury and repair in
a malignant nephrosclerosis model
#MMPMID24958497
Griffin KA
; Polichnowski A
; Litbarg N
; Picken M
; Venkatachalam MA
; Bidani AK
Hypertension
2014[Oct]; 64
(4
): 801-7
PMID24958497
show ga
Most patients with essential hypertension do not exhibit substantial renal
damage. Renal autoregulation by preventing glomerular transmission of systemic
pressures has been postulated to mediate this resistance. Conversely, malignant
nephrosclerosis (MN) has been postulated to develop when severe hypertension
exceeds a critical ceiling. If the concept is valid, even modest blood pressure
(BP) reductions to below this threshold regardless of antihypertensive class (1)
should prevent MN and (2) lead to the healing of the already developed MN
lesions. Both predicates were tested using BP radiotelemetry in the stroke-prone
spontaneously hypertensive rats receiving 1% NaCl as drinking fluid for 4 weeks.
Severe hypertension (final 2 weeks average systolic BP, >200 mm Hg) and MN
(histological damage score 36±5; n=27) developed in the untreated stroke-prone
spontaneously hypertensive rats but were prevented by all antihypertensive
classes (enalapril [n=15], amlodipine [n=13], or a
hydralazine/hydrochlorothiazide combination [n=15]) if the final 2-week systolic
BP remained <190 mm Hg. More impressively, modest systolic BP reductions to 160
to 180 mm Hg (hydralazine/hydrochlorothiazide regimen) initiated at ?4 weeks in
additional untreated rats after MN had already developed (injury score 35±4 in
the right kidney removed before therapy) led to a striking resolution of the
vascular and glomerular MN injury over 2 to 3 weeks (post-therapy left kidney
injury score 9±2, P<0.0001; n=27). Proteinuria also declined rapidly from 122±9.5
mg/24 hours before therapy to 20.5±3.6 mg 1 week later. These data clearly
demonstrate the barotrauma-mediated pathogenesis of MN and the striking capacity
for spontaneous and rapid repair of hypertensive kidney damage if new injury is
prevented.
|*Disease Models, Animal
[MESH]
|Amlodipine/pharmacology
[MESH]
|Animals
[MESH]
|Antihypertensive Agents/pharmacology
[MESH]
|Blood Pressure/drug effects/*physiology
[MESH]
|Drug Therapy, Combination
[MESH]
|Enalapril/pharmacology
[MESH]
|Humans
[MESH]
|Hydralazine/pharmacology
[MESH]
|Hydrochlorothiazide/pharmacology
[MESH]
|Hypertension/*physiopathology/prevention & control
[MESH]
|Male
[MESH]
|Nephrosclerosis/*physiopathology/prevention & control
[MESH]