In hypertension, the kidney is not always the heart of the matter
J. Clin. Invest. Michael E. Mendelsohn, et al. 115:840 doi:10.1172/JCI24806 [Go to this article.]

Figure 1
An alternative model for the pathogenesis of hypertension. According to the prevailing model for hypertension, a renal abnormality in salt handling is the initiating factor. In the alternative model discussed here, hypertension arises de novo from primary, intrinsic abnormalities of the VSMC proteins that regulate contractile state. At least 2 mechanisms can be envisioned. Alterations in the set point of resting vascular tone of the resistance arteries could modify blood pressure by directly increasing SVR. Alternatively, intrinsic abnormalities in the VSMCs of renal vessels could alter renal vascular tone and perfusion, secondarily creating the recognized effects on renal function that promote and/or sustain blood pressure elevations. In either case, a focus on those regulatory proteins in the final common pathway regulating VSMC tone suggests new diagnostic and therapeutic approaches to abnormalities of blood pressure. Figure modified with permission from Cell (3).