The Kidney, Hypertension, and Obesity
Abstract
This paper provides a personal perspective of the role of abnormal renal-pressure natriuresis in the pathogenesis of hypertension. Direct support for a major role of renal-pressure natriuresis in long-term control of arterial pressure and sodium balance comes from studies demonstrating that (1) pressure natriuresis is impaired in all forms of chronic hypertension and (2) prevention of pressure natriuresis from operating, by servo-control of renal perfusion pressure, also prevents the maintenance of sodium balance hypertension. Although the precise mechanisms of impaired pressure natriuresis in essential hypertension have remained elusive, recent evidence suggests that obesity and overweight may play a major role. Obesity increases renal sodium reabsorption and impairs pressure natriuresis by activation of the renin-angiotensin and sympathetic nervous systems and by altered intrarenal physical forces. Chronic obesity also causes marked structural changes in the kidneys that eventually lead to a loss of nephron function, further increases in arterial pressure, and severe renal injury in some cases. Although there are many unanswered questions about the mechanisms of obesity hypertension and renal disease, this is one of the most promising areas for future research, especially in view of the growing, worldwide “epidemic” of obesity.
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All forms of hypertension, including obesity hypertension, are associated with impaired renal-pressure natriuresis.
“previous studies suggest that all forms of hypertension, including obesity hypertension, are associated with impaired renal-pressure natriuresis5.”
From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [5]
Studies in diverse populations show that the relationship between BMI and systolic and diastolic blood pressure is nearly linear.
“Studies in diverse populations throughout the world have shown that the relationship between BMI and systolic and diastolic blood pressure (BP) is nearly linear5,6.”
From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [5]
The metabolic, endocrine, cardiovascular, and renal changes caused by dietary-induced obesity in dogs and rabbits closely mimic the changes observed in obese humans.
“The metabolic, endocrine, cardiovascular, and renal changes caused by dietary-induced obesity in these experimental animals closely mimic the changes observed in obese humans5,13–16 (Table 1).”
From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [5]
Increased sympathetic nervous system (SNS) activity is a mediator of abnormal kidney function and increased blood pressure during development of obesity hypertension.
“3) increased sympathetic nervous system (SNS) activity”
From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [5]
Multiple lines of evidence indicate that increased SNS activity contributes to obesity hypertension.
“Multiple lines of evidence indicate that increased SNS activity contributes to obesity hypertension5,12:”
From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [5]
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Avolio, E., Gualtieri, P., Romano, L., Pecorella, C., Ferraro, S., Palma, G., Di Renzo, L., & De Lorenzo, A. (2020) · Current Medicinal Chemistry · doi:10.2174/0929867326666190326113607 · Cited by 43 · see citing works
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Control of metabolic and cardiovascular function by the leptin–brain melanocortin pathway
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Self-citationOedema in obesity; role of structural lymphatic abnormalities
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- Authors
- Hall, J. E.
- Affiliations
- University of Mississippi Medical Center (US)
- Corresponding author
- Hall, John E.
- ORCID
- Hall, John E.
- Venue
- Hypertension
- Published
- 2003-03
- Volume
- 41
- Issue
- 3
- Pages
- 625-633
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2021305708
- Cited by
- 868
- References
- 57
- Citations by year
- 2026: 18 · 2025: 14 · 2024: 26 · 2023: 20 · 2022: 27 · 2021: 36 · 2020: 29 · 2019: 38 · 2018: 29 · 2017: 33 · 2016: 37 · 2015: 36 · 2014: 45 · 2013: 47 · 2012: 72
- FWCI
- 27.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- pressure natriuresis, obesity, essential hypertension, sodium balance, renal sodium reabsorption, renin-angiotensin system, sympathetic nervous system, renal perfusion pressure, nephron function, kidney injury
- MeSH terms
- Blood Pressure, Hormones, Humans, Hypertension, Kidney, Models, Biological, Natriuresis, Obesity, Renin-Angiotensin System, Sodium, Sympathetic Nervous System, Vasoconstriction, Water-Electrolyte Balance, Feedback, Physiological, History, 19th Century, History, 20th Century, History, Ancient
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