T he late Arthur Guyton had postulated that even in the absence of primary renal disease of the kidney, a change in renal function, more precise, resetting of the BP/natriuresis relationship, is a prerequisite for a persistent rise of BP (1,2). The hypothesis that resetting of renal sodium handling plays a dominant role in the genesis of "essential hypertension," which is undoubtedly a polygenic condition, is further supported by the findings in monogenic forms of hypertension: Virtually all forms identified so far (3,4) have turned out to be linked to increased tubular net reabsorption of sodium.The postulate of an overriding role of the kidney has not gone uncontested, however, and the results of a number of studies have been interpreted to indicate that persistent BP elevation may also be caused by primary changes of resistance vessels (5-8). This argument is weakened by the objection that co-involvement of the renal vasculature has not been consistently excluded in these studies. This point is of interest, because-at least in the model of the spontaneously hypertensive rat-narrowing of the afferent arterioles precedes the rise in BP and presumably contributes to it (9).Despite their mostly normal plasma renin activity even in patients with essential hypertension, the BP frequently responds to angiotensin-converting enzyme inhibitors, suggesting that the renin-angiotensin system (RAS) plays a pathogenetic role, an effect that obviously must be mediated through the angiotensin II (AngII) type 1 (AT1) receptor. It is true that transplantation of the kidney of an immunocompatible wild-type mouse into a mouse that lacks the AT1 receptor does not fully restore the BP to normal values, suggesting that extrarenal territories make at least some nonredundant contribution to BP regulation (10), but this observation by no means excludes an overriding role of the renal RAS in the long-term regulation of BP.Apart from the kidney, the AT1 receptor is expressed in several tissues that might well contribute to long-term BP regulation: Vessels (11), adrenal glands (12), and particularly cardiovascular control centers in the brain (13). A potential role of the latter in the regulation of BP would not be unexpected given the massive hypotensive response to intracerebroventricular injection of angiotensin receptor blockers (14).An overriding role of such extrarenal AT1 receptors could be excluded, however, by the elegant experiment by Crowley et al. (15), which used isolated manipulation of the renal AT1 receptor. Another recent controversy that was addressed by this study (15) has focused on the issue of whether blockade of the RAS has BP-independent beneficial effects on hypertensioninduced target organ damage, particularly on left ventricular hypertrophy (LVH). Meta-analyses had suggested more rapidly appearing and more intense reversal of LVH under blockade of the RAS compared with alternative antihypertensive agents (16), but such clinical observations do not definitely exclude confounding, among others, by differences betw...