Pathogenesis of Essential Hypertension

Smirk, F. H.

doi:10.1136/bmj.1.4609.791

Cited by 59 publications

(12 citation statements)

References 38 publications

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“…Elevated blood pressures, even though produced genetically and physiologically, predispose to and lead in the course of time to characteristic pathological changes in the heart and circulation (Smirk, 1946(Smirk, , 1949(Smirk, , 1967(Smirk, , 1972. Some of the changes represent work hypertrophy of heart and blood vessels and others are accelerated involutionary changes.…”

Section: Discussionmentioning

confidence: 96%

Casual, Basal and Supplemental Blood Pressures in 519 First-Degree Relatives of Substantial Hypertensive Patients and in 350 Population Controls

Smirk

1976

Clinical Science

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SmmarY1. The casual blood pressure is the sum of the relatively stable basal pressure taken under defined conditions of rest and the labile supplemental pressure (casual minus basal), which represents the response to the current degree of physical, mental and probably metabolic stimulation.2. The basal and supplemental blood pressures behave differently and it seems likely that different factors are involved in their pathogenesis.3. The 5 and 8 years follow-up mortality is closely related to the basal pressure but not to the supplemental pressure.4. The rise with age in the basal blood pressure is greater in the relatives of substantial hypertensive patients than in population control subjects.5. Above the age group 30-39 years there is an increase in the rate of rise of the mean basal blood pressure with age among the first-degree relatives of hypertensive patients. In a population control group an acceleration in the rate of rise of the mean basal blood pressure with age also occurs but a decade or more later than in the relatives of hypertensive patients.6. In males the mean supplemental pressures (systolic and diastolic) do not rise appreciably with age and the mean supplemental pressures of first-degree relatives and control subjects do not differ appreciably. 7.In females the mean supplemental pressures rise with age but, except after age 60 years, the pressure rise in first-degree relatives is only a little greater than in control subjects.8. When hypertensive patients with similar casual blood pressures are compared the basal blood pressures are higher in patients with glomerulonephritis than in essential hypertensive patients. 9. In the first-degree relatives of substantial hypertensive patients high-ranking basal blood pressures occur much more frequently than in general population control subjects.10. The close resemblance of the blood pressures in like twins indicates that genetic or familial factors have an important influence on blood pressure, and on the Occurrence of frank hypertension.

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Section: Discussionmentioning

confidence: 96%

Casual, Basal and Supplemental Blood Pressures in 519 First-Degree Relatives of Substantial Hypertensive Patients and in 350 Population Controls

Smirk

1976

Clinical Science

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“…Nevertheless, reviewers of the literature12' [14][15][16] 22 The cause of the low blood pressure remains to be determined, but a possible contributing factor is the smallness in stature and lightness of weight, which is also a feature of the Chinese.23 The higher pressures in the women despite their lighter weight, as compared to the men, might be related to their lesser degree of physical activity. 24 The blood pressure in the Bushmen does not appear to increase with age, a feature in marked contrast to that described in European25, 26 and in American populations,27 where blood pressure is a "graded characteristic" continuously increasing with age.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure in Bushmen of the Kalahari Desert

Kaminer

Lutz

1960

Circulation

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The blood pressure was studied in 42 males and 36 females in 2 groups of nomadic Bushmen, living near Ghanzi in the Kalahari Desert, as well as in a third group of 21 Bushmen prisoners and farm laborers from the same region. The pressures were also "corrected" for arm girth. The average systolic pressures were 108.4 mm. Hg (S.D. 11.4) for men and 112.8 mm. Hg (S.D. 14.6) for women. The average diastolic pressures were 66.2 mm. Hg (S.D. 6.9) and 69.6 mm. Hg (S.D. 8.0) for men and women, respectively. These pressures with stated exception, are considered to be lower than for most populations. In the women, the systolic and diastolic pressures were higher than those in the men. The blood pressure showed no tendency to rise with age, an observation in contrast to that found in most other populations. It was suggested that an increase of the blood pressure with age may be an indication of the existence of essential hypertension within that population. The blood pressures of Bushmen prisoners and farm laborers were higher than those in nomadic Bushmen. Further investigation is needed of the genetic and environmental factors affecting the blood pressure in the nomadic Bushmen.

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“…The insulin sensitivity index was calculated using the MINMOD program, as previously reported [11,19]. The urinary excretion of sodium and potassium was factored by creatinine.…”

Section: Na/li-countertransportmentioning

confidence: 99%

Abnormalities in Insulin Sensitivity, Vascular Resistance and Erythrocyte Cation Transport are Independent Genetic Traits in Familial Hypertension

FERRARI

1999

Blood Pressure

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Several isolated abnormalities have been noted in normotensive members of hypertensive families, including exaggerated forearm vascular resistance (FVR), decreased insulin sensitivity and elevated sodium-lithium (Na/Li) countertransport. No family study has investigated the aforementioned abnormalities concurrently within the same hypertensive families. It is therefore unknown whether these disturbances reflect single or different genetic traits. Thus, we studied cardiovascular reactivity of the forearm vasculature, cellular sodium transport mechanisms and insulin sensitivity concomitantly in normotensive (n = 24) and borderline hypertensive (n = 16) members of hypertensive families, compared with normotensive members (n = 24) of normotensive families. At least one abnormality was noted in 27 (67%) out the 40 subjects with a positive family history of hypertension. Na/Li-countertransport was increased in 15 (37%), FVR was increased in 14 (35%) and insulin sensitivity was decreased in 9 (22%) subjects with familial hypertension. The concomitant occurrence of at least 2 out of the 3 abnormalities mentioned was noted in 9 (22%) out of the 40 subjects with family history of hypertension. Decreased insulin sensitivity, increased basal FVR and increased Na/Li countertransport were concurrently observed in two (5%) subjects. This investigation documents the frequent occurrence of abnormalities such as decreased insulin sensitivity, increased basal FVR and Na/Li-countertransport in subjects with family history of hypertension. The concomitant occurrence of at least two of the mentioned abnormalities being observed in less than one-quarter of the subjects with family history of essential hypertension, it is assumed that insulin sensitivity, basal FVR and Na/Li-countertransport reflect more than one genetic trait predisposing to hypertension.

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Pathogenesis of Essential Hypertension

Cited by 59 publications

References 38 publications

Casual, Basal and Supplemental Blood Pressures in 519 First-Degree Relatives of Substantial Hypertensive Patients and in 350 Population Controls

Casual, Basal and Supplemental Blood Pressures in 519 First-Degree Relatives of Substantial Hypertensive Patients and in 350 Population Controls

Blood Pressure in Bushmen of the Kalahari Desert

Abnormalities in Insulin Sensitivity, Vascular Resistance and Erythrocyte Cation Transport are Independent Genetic Traits in Familial Hypertension

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