A unifying pathway for essential hypertension

Richard J. Johnson, Bernardo Rodriguez-Iturbe, Duk Hee Kang, Daniel I. Feig, Jaime Herrera-Acosta

Research output: Contribution to journalReview articlepeer-review

140 Scopus citations


We present the hypothesis that most cases of essential hypertension occur via two phases. The first phase is initiated by episodes of renal vasoconstriction induced by a hyperactive sympathetic nervous system, activation of the renin-angiotensin system, or hyperuricemia resulting from diet or genetics. During this phase the hypertension is salt resistant and renin dependent, and the kidney normal. Over time, preglomerular vascular disease develops (arteriolosclerosis), associated with tubulointerstitial inflammation; this shifts the hypertension to a salt-sensitive, volume-dependent, and renal-dependent pathway. This pathway unites many of the previous hypotheses on the etiology of hypertension, and offers insights into ways to prevent, ameliorate, or cure the underlying process.

Original languageEnglish
Pages (from-to)431-440
Number of pages10
JournalAmerican Journal of Hypertension
Issue number3
StatePublished - Mar 2005

Bibliographical note

Funding Information:
Support for this work was provided by National Institutes of Health grants DK-52121, HL-68607, and a George O’Brien Center grant (DK-P50-DK064233).


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