Essential Hypertension and Its Causes: Neural and Non-Neural Mechanisms

Hardcover | April 15, 2007

byPaul I. Korner

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This new account of the pathogenesis of essential hypertension (EH) represents a detailed analysis of the main components of the circulatory control system. The latter's properties resemble those of man-made adaptive control systems in which regulatory parameters are altered when operatingconditions exceed certain limits, often through neural mechanisms. Inheritance of EH depends on both genes and environment. The high blood pressure (BP) genes have not yet been definitively identified, whilst the main environmental causes are mental stress, high dietary salt intake and obesity. EH occurs as two major syndromes, each initiated by chronic stress: 1)Stress-and-salt related EH, and 2) Hypertensive obesity. Stress is perceived by the cortex, from which increased dopaminergic (DA) neuron activity stimulates the hypothalamic defense area, raising sympathetic neural activity (SNA) and BP. Normally these subside quickly when the stress is over,but in those susceptible to EH the DA synapses become sensitized so that the defense response is evoked by ever lower levels of stress. Sensitization is common in memory circuits, but not in autonomic neurons, so that this property in EH may be genetically determined. Stress-related hypertension increases hypothalamic responsiveness to high salt, resulting in further rises in SNA and BP. Later, non-neural functional changes (e.g. reduction in nitric oxide) and the structural remodeling of resistance vessels further enhance the vasoconstriction. In contrast, inthose developing hypertensive obesity food consumption is excessive, which transiently alleviates stress-related anxiety. The brain ignores the leptin-mediated signals that normally curb appetite, contrasting with normal energy regulation in SSR-EH. In hypertensive obesity, the SNA pattern issimilar to that in SSR-EH, but vasoconstriction is masked by vasodilatation and fluid retention due to hyperinsulinemia. This syndrome is a volume overload hypertension, where high cardiac output, renal impairment and other non-neural factors contribute to the elevation of BP. Other topics include the role of various transmitters in autonomic regulation; the place of baroreflexes in the intact organism; why exercise training lowers resting BP; obstructive sleep apnea; non-pharmacological and drug treatment of EH; the role of the kidney in EH and in different types ofrenal hypertension and the pathogenesis of the Japanese spontaneously hypertensive rat, which provides a valuable animal model for EH. The work suggests that physiological systems analysis in a complex disorder like EH is a valuable tool for using the great advances in molecular biology to best advantage.

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This new account of the pathogenesis of essential hypertension (EH) represents a detailed analysis of the main components of the circulatory control system. The latter's properties resemble those of man-made adaptive control systems in which regulatory parameters are altered when operatingconditions exceed certain limits, often through...

Paul Korner is Emeritus Professor of Medicine, Monash University, and Emeritus Director of the Baker Medical Research Institute. He was Foundation Professor of Physiology, University of New South Wales (1960-68); Scandrett Professor of Cardiology, University of Sydney (1968-1974); Director of the Baker Medical Research Institute and P...

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Format:HardcoverDimensions:720 pages, 6.18 × 9.41 × 1.61 inPublished:April 15, 2007Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0195094832

ISBN - 13:9780195094831

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Table of Contents

Preface. Table of Contents. Acknowledgements. I. Introduction. 1. A Short History and some Clinical AspectsII. Biological Control. 2. The Nature of the Cardiovascular Control System3. Blood Pressure GeneticsIII. Output Analysis: Pointers to Neural Involvement. 4. Determinants of Long-Term Elevation of Arterial Pressure5. Output Patterns in Non-Obese HypertensivesIV. Intrinsic Cardiovascular Properties in Hypertension. 6. The Peripheral Vascular Integrator7. Cardiac PerformanceV. Cellular and Integrative Aspects of Circulatory Control. 8. CNS Cardiovascular Pathways: Role of Fast and Slow Transmitters9. "Whole Organism" Baroreflexes10. Exercise Training and its Long-Term Effects on Blood Pressure: Linkage to Somatic MovementVI. The Brain as the Source of Lifestyle-Related Hypertension. 11. Psychosocial Stress and Hypertension12. Salt, Other Dietary Factors, and Blood Pressure13. Normotensive and Hypertensive Obesity14. Obstructive Sleep ApnoeaVII. Neural Involvement in other Types of Hypertension. 15. More About the Kidney in Hypertension16. SHR Hypertension and its CausesVIII. Synthesis. 17. Pathogenesis of Essential Hypertension: Implications for Prevention and TreatmentIndex.

Editorial Reviews

"Dr. Korner successfully integrates vast amounts of information learned from research on the pathogenesis of essential hypertension into one comprehensive reference. Initial alterations of neural pressure regulatory system are expertly detailed providing targeted areas for expandedresearch."--Doody's