Roles of the kidneys and fluid volumes in arterial pressure regulation and hypertension. 1989

A C Guyton
Department of Physiology and Biophysics, University Medical Center, Jackson, Mississippi 39216.

The goal of this paper has been to show that the renal-fluid volume mechanism for control of the arterial pressure is an extremely powerful one, so powerful that it is either impossible or almost impossible for the arterial pressure ever to be adjusted to any other value besides the level dictated by this mechanism. The reason for the extreme potency of this mechanism for pressure control is that it never stops working until the intake and output of salt and fluid volume come to an exact state of equilibration. This occurs where the salt and water intake line, as illustrated in Figure 3, crosses the renal function curve which expresses the relationship between arterial pressure and fluid output by the kidneys. Some of the factors that make this renal-fluid volume mechanism such an excellent pressure regulator are the following: First, once the baroreceptor mechanism for pressure control has adapted, the systemic arterial pressure is affected greatly by the levels of extracellular fluid volume and blood volume. Second, the blood flow autoregulation mechanism further enhances the effect of slight changes in fluid volume on pressure, increasing the effectiveness of the pressure control system at least five times additional. Third, the renin-angiotensin system also plays a major role in increasing the sensitivity of this pressure control system. When salt intake becomes very great, renal output of renin and subsequent formation of angiotensin both decrease drastically. This shifts the renal function curve back toward a lower pressure level, thus compensating for most of the increase in pressure that would otherwise occur as a result of the increased salt intake. Putting all the above factors together, one finds that very slight changes in the fluid volume level in the body can have drastic effects on pressure. And, conversely, very slight changes in arterial pressure above or below the normal level can initiate large changes in urinary output of salt and water, thus rapidly returning the pressure back to that level at which intake and output of water and salt are in balance.

UI MeSH Term Description Entries
D006973 Hypertension Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more. Blood Pressure, High,Blood Pressures, High,High Blood Pressure,High Blood Pressures
D007668 Kidney Body organ that filters blood for the secretion of URINE and that regulates ion concentrations. Kidneys
D011311 Pressoreceptors Receptors in the vascular system, particularly the aorta and carotid sinus, which are sensitive to stretch of the vessel walls. Baroreceptors,Receptors, Stretch, Arterial,Receptors, Stretch, Vascular,Stretch Receptors, Arterial,Stretch Receptors, Vascular,Arterial Stretch Receptor,Arterial Stretch Receptors,Baroreceptor,Pressoreceptor,Receptor, Arterial Stretch,Receptor, Vascular Stretch,Receptors, Arterial Stretch,Receptors, Vascular Stretch,Stretch Receptor, Arterial,Stretch Receptor, Vascular,Vascular Stretch Receptor,Vascular Stretch Receptors
D012084 Renin-Angiotensin System A BLOOD PRESSURE regulating system of interacting components that include RENIN; ANGIOTENSINOGEN; ANGIOTENSIN CONVERTING ENZYME; ANGIOTENSIN I; ANGIOTENSIN II; and angiotensinase. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming ANGIOTENSIN I. Angiotensin-converting enzyme, contained in the lung, acts on angiotensin I in the plasma converting it to ANGIOTENSIN II, an extremely powerful vasoconstrictor. Angiotensin II causes contraction of the arteriolar and renal VASCULAR SMOOTH MUSCLE, leading to retention of salt and water in the KIDNEY and increased arterial blood pressure. In addition, angiotensin II stimulates the release of ALDOSTERONE from the ADRENAL CORTEX, which in turn also increases salt and water retention in the kidney. Angiotensin-converting enzyme also breaks down BRADYKININ, a powerful vasodilator and component of the KALLIKREIN-KININ SYSTEM. Renin-Angiotensin-Aldosterone System,Renin Angiotensin Aldosterone System,Renin Angiotensin System,System, Renin-Angiotensin,System, Renin-Angiotensin-Aldosterone
D001794 Blood Pressure PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS. Systolic Pressure,Diastolic Pressure,Pulse Pressure,Pressure, Blood,Pressure, Diastolic,Pressure, Pulse,Pressure, Systolic,Pressures, Systolic
D001826 Body Fluids Liquid components of living organisms. Body Fluid,Fluid, Body,Fluids, Body
D006706 Homeostasis The processes whereby the internal environment of an organism tends to remain balanced and stable. Autoregulation
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000222 Adaptation, Physiological The non-genetic biological changes of an organism in response to challenges in its ENVIRONMENT. Adaptation, Physiologic,Adaptations, Physiologic,Adaptations, Physiological,Adaptive Plasticity,Phenotypic Plasticity,Physiological Adaptation,Physiologic Adaptation,Physiologic Adaptations,Physiological Adaptations,Plasticity, Adaptive,Plasticity, Phenotypic
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia

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