Renal Circulation

Knox, Franklyn G.; Spielman, William S.

doi:10.1002/cphy.cp020306

Cited by 6 publications

(5 citation statements)

References 228 publications

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“…27 This favors an alternative hypothesis, ie, that the heart responds differently to treatment- induced BP reductions because of less pronounced ability to maintain its perfusion at lower BP values compared with the brain and the kidney, in which blood flow autoregulation is extremely effective over a wide BP range. 28,29 Several other points deserve mention. First, an important new finding of the present study is that the effects on CV events of BP control, as calculated for many visits, were substantially reproduced by the time-dependent analysis that related the occurrence of an end point to BP control in the immediately preceding visit.…”

Section: Mancia Et Al Target Blood Pressure and CV Protectionmentioning

confidence: 99%

Blood Pressure Targets Recommended by Guidelines and Incidence of Cardiovascular and Renal Events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)

Mancia

Schumacher

Redón³

et al. 2011

Circulation

164

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Background-Hypertension treatment guidelines recommend that blood pressure (BP) be lowered to Ͻ140/90 mm Hg, but that a reduction to Ͻ130/80 mm Hg be adopted in patients at high cardiovascular (CV) risk. We investigated the CV and renal benefits associated with these BP targets in the high-CV-risk population of the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET). Methods and Results-Patients were divided into 4 groups according to the proportion of in-treatment visits before the occurrence of an event (Ͻ25%-Ͼ75%) in which BP was reduced to Ͻ140/90 or Ͻ130/80 mm Hg. After adjustment for demographic and clinical variables, a progressive increase in the proportion of visits in which BP was reduced to Ͻ140/90 or Ͻ130/80 mm Hg was associated with a progressive reduction in the risk of stroke, new onset of microalbuminuria or macroalbuminuria, and return to normoalbuminuria in albuminuric patients. An increased frequency of BP control to either target did not have any consistent effect on the adjusted risk of myocardial infarction and heart failure. The adjusted risk of CV events was reduced by increasing the frequency of BP control to Ͻ140/90 mm Hg, but not to Ͻ130/80 mm Hg. Similar findings were obtained for the achievement of the BP target in the visit preceding a CV event. Conclusion-The more frequent achievement of the BP targets recommended by guidelines led to cerebrovascular and renal protection, but did not increase cardiac protection. Overall, CV protection was favorably affected by the less tight but not by the tighter BP target. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00153101.

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Section: Mancia Et Al Target Blood Pressure and CV Protectionmentioning

confidence: 99%

Blood Pressure Targets Recommended by Guidelines and Incidence of Cardiovascular and Renal Events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)

Mancia

Schumacher

Redón³

et al. 2011

Circulation

164

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“…75 A pronounced fall in blood pressure exists along the afferent and efferent arterioles. 73 -75 - 76 Average glomerular capillary pressures are assumed to be 45 mm Hg for superficial glomeruli 73 and 65 mm Hg for juxtamedullary glomeruli. 73 The profile of the pressure in postglomerular circulation given by different investigators is very variable.…”

Section: Intrarenal Profile Of Vascular Hydrostatic Pressure In Restimentioning

confidence: 99%

“…73 -75 - 76 Average glomerular capillary pressures are assumed to be 45 mm Hg for superficial glomeruli 73 and 65 mm Hg for juxtamedullary glomeruli. 73 The profile of the pressure in postglomerular circulation given by different investigators is very variable. In a complete review of the subject, Ofstad and Aukland 75 indicated that postglomerular resistance is markedly affected by the functional state of the kidney.…”

Section: Intrarenal Profile Of Vascular Hydrostatic Pressure In Restimentioning

confidence: 99%

“…On the basis of these data, we have ascribed values of 10 and 20 mm Hg at the end of superficial and juxtamedullary efferent arterioles. The existing pressure along peritubular capillaries in the renal cortex is assumed to drop from 10 to 2 mm Hg, 73 -" while the drop of pressure along the vasa recta is from 20 to 1 mm Hg. 77 The relationship of Starling forces in peritubular capillaries, with respect to the interstitial pressures, has been extensively considered by other investigators as part of the glomerular tubular balance.…”

Section: Intrarenal Profile Of Vascular Hydrostatic Pressure In Restimentioning

confidence: 99%

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Mechanisms underlying pressure-related natriuresis: the role of the renin-angiotensin and prostaglandin systems. State of the art lecture.

1988

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SUMMARY It has long been known that increments in renal perfusion pressure can induce an elevation of urine sodium excretion without changing renal blood flow or glomerular filtration rate. The mechanism underlying this pressure-related natriuresis remains undefined, although the interest in its elucidation has been stimulated by the notion that it may constitute the central phenomenon through which the kidney regulates blood volume and, thereby, blood pressure. Recently, the use of novel experimental techniques has disclosed some important clues about changes in renal hemodynamics that, along with changes in renal humoral regulators, allow us to visualize a possible sequence of events responsible for pressure-related natriuresis. According to this hypothesis, the autoregulatory responses responsible for maintaining glomerular filtration rate are elicited in preglomerular vasculature by changes in renal perfusion pressure. These myogenic responses are coupled through Ca 2+ entry in juxtaglomerular cells with inversely related changes in the release of renin and, consequently, with the amount of angiotensin II generated in renal interstitium. The release of renin from juxtaglomerular cells is modulated by the synthesis of prostaglandin I 2 from the adjacent endothelial cells. Interstitial angiotensin II could influence sodium tubular reabsorption directly by stimulating sodium transport in proximal renal tubules and indirectly by altering medullary blood flow and, thereby, medullary interstitial pressure. In the renal medulla, the effects of interstitial pressure on sodium reabsorption can be amplified by the release of prostaglandin E 2 from interstitial cells. A deficient regulation of this relationship could result in a shift of the pressure-natriuresis curve, leading to hypertension. (Hypertension 11: 724-738, 1988) KEY WORDS • prostaglandins • renin-angiotensin system • medullary blood flow • renal blood flow • glomerular filtration rate • hypertension I T has long been recognized that the kidney alters urine flow and sodium excretion 1 2 in response to acute changes in renal perfusion pressure (RPP).3 4 Since the glomerular filtration rate (GFR) is well autoregulated (Figure 1), pressure-related natriuresis is the result of decreased reabsorption of sodium by the renal tubules rather than increased filtered load. 4 The mechanisms responsible for changes in sodium reabsorption have not been fully denned, but interest in its elucidation has been maintained ever since pressure-related natriuresis was conceptually placed at the

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“…The same rule may apply also to renal protection because studies on nephropatic patients have shown that the incidence of renal events (end-stage renal disease, dialysis, transplantation, etc) and the effects on markers of renal dysfunction such as reduced glomerular filtration rate, microalbuminuria, and proteinuria undergo a progressive improvement down to very low BP values. 13,14 The explanation may lie in the excellent blood flow autoregulation properties of the brain 15 and kidney, 16 which allows perfusion of these organs to be preserved also at low BP values. It is also possible, however, that because recruitment in INVEST and ONTARGET (but not in PROGRESS) involved mainly individuals with a history of coronary disease, the results of these trials reflect a clinical circumstance in which the mechanisms preserving blood flow at low BP values were selectively impaired in the heart.…”

mentioning

confidence: 99%

Effects of Intensive Blood Pressure Control in the Management of Patients With Type 2 Diabetes Mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

Mancia

2010

Circulation

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Renal Circulation

Cited by 6 publications

References 228 publications

Blood Pressure Targets Recommended by Guidelines and Incidence of Cardiovascular and Renal Events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)

Blood Pressure Targets Recommended by Guidelines and Incidence of Cardiovascular and Renal Events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)

Mechanisms underlying pressure-related natriuresis: the role of the renin-angiotensin and prostaglandin systems. State of the art lecture.

Effects of Intensive Blood Pressure Control in the Management of Patients With Type 2 Diabetes Mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

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