THE HYPERTENSION PARADIGM

Hypoxic pulmonary hypertension: the paradigm is changing

Sustained hypoxia caused by migration of native sea-level dwellers to high altitude or by chronic lung disease leads to the development of increased pulmonary vascular resistance and pulmonary hypertension, a response to hypoxia that is unique to the pulmonary circulation. In susceptible individuals at high altitude (subacute and chronic mountain sickness) and in lung disease, the resultant pul...

Hypertension and chronotherapy: shifting the treatment paradigm.

The treatment of diseases has been based on the concept of homeostasis and has not incorporated an understanding of biologic rhythms and their underlying mechanisms. Biologic rhythms are implicated in cardiovascular events. Failure to recognize the circadian decline in blood pressure may result in iatrogenic chronopathological events, including anterior ischemic optic neuropathy and cerebrovasc...

Hypertension in an anthropological and evolutionary paradigm.

‘‘The contingent, stochastic nature of genetic evolution [provides a]. . .historical trail [to help us] to identify genes affecting a trait, understand their origins, and to refine our ability to do genetic screening.”1 A renaissance is occurring in the field of molecular evolution. The reframing of questions about pathophysiology and disease in an evolutionary perspective is providing new insi...

The iron paradigm of pulmonary arterial hypertension: Popeye knows best.

Role of the kidney in the pathogenesis of hypertension: time for a neo-Guytonian paradigm or a paradigm shift?

The "Guytonian paradigm" places the direct effect of arterial pressure, on renal excretion of salt and water, at the center of long-term control of blood pressure, and thus the pathogenesis of hypertension. It originated in the sixties and remains influential within the field of hypertension research. However, the concept of one central long-term feedback loop, through which arterial pressure i...