The kidney in essential hypertension. Victim or culprit.

THE frequent association of hypertension and intrinsic renal diseases has been universally recognized, and more recently a relationship has been demonstrated between hypertension and the concurrence of major renal artery disease and specific renal functional abnormalities. In searching for the etiology of essential hypertension, it seems logical, therefore, to consider the possibility that here also the kidney may play a causal role. In examining this thesis, we have found renal functional abnormalities which suggest that essential hypertension may arise from an alteration in perfusion of the kidney differing only in extent and site from that in renal artery stenosis. We are presenting here a brief summary of the evidence bearing on the guilt or innocence of the kidney in essential hypertension. The high incidence of renal arteriolosclerosis in patients with established hypertensive disease has been cited to support the thesis that disease of the smaller renal vessels plays a primary role in the causation of hypertension.1 Moritz and Oldt2 re-examined this relationship in 100 patients with well-established hypertension of many years' duration and in a well-controlled study found renal arteriolosclerosis at necropsy in 97%. Absence of arteriolosclerosis, on the other hand, may just as reasonably be offered as evidence