A narrative review of Hyporeninemic hypertension-an indicator for monogenic forms of hypertension.

Pediatric medicine (Hong Kong, China) Pub Date : 2022-05-01 Epub Date: 2022-05-28 DOI:10.21037/pm-21-48
Ahmad Mashmoushi, Matthias T F Wolf
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引用次数: 2

Abstract

Background and objective: While the role of the renin-angiotensin-aldosterone system (RAAS) in the development of hypertension is well known, the significance and contribution of low renin hypertension is often overlooked. RAAS stimulation results in more tubular absorption of sodium and water along the nephron, contributing to a higher circulating vascular volume. In addition, members of the RAAS system, such as angiotensin II, have direct effects on vascular vasoconstriction, the heart, aldosterone synthesis in the adrenal glands, the sympathetic nervous system, and the central nervous system. This has resulted in a line of antihypertensive therapeutics targeting RAAS with angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and renin inhibitors, which prevent conversion of angiotensinogen to angiotensin. While general practitioners and nephrologists are well aware of the causes and the long-term consequences of elevated renin and aldosterone levels, the opposite situation with low renin and/or low aldosterone levels is frequently underappreciated. The objective of this review is to provide insight to the less common forms of hyporeninemic hypertension.

Methods: We searched the PubMed online library for keywords related to hyporeninemic hypertension and focused on the pediatric population. For pathophysiology we focused on literature of the last 5 years.

Key content and findings: The low renin and aldosterone levels may be indicators of inherited (especially when associated with hypokalemia), monogenic forms of hypertension stimulating excessive tubular sodium and water absorption which subsequently results in plasma volume expansion and hypertension. These forms of hypertension require frequently specific forms of therapy. This underlines the importance of the practitioner to be familiar with these rare diseases.

Conclusions: In this review article, we outline the different forms of hypertension characterized by low renin/low aldosterone and low renin/high aldosterone levels, how to diagnose these forms of hypertension, and how to treat them.

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低肾素性高血压的叙述性回顾-单基因高血压的一个指标。
背景与目的:虽然肾素-血管紧张素-醛固酮系统(RAAS)在高血压发生中的作用众所周知,但低肾素高血压的重要性和贡献往往被忽视。RAAS刺激导致更多的钠和水沿着肾元的管状吸收,有助于更高的循环血管体积。此外,RAAS系统的成员,如血管紧张素II,对血管收缩、心脏、肾上腺醛固酮合成、交感神经系统和中枢神经系统有直接影响。这导致了一系列针对RAAS的降压治疗药物,包括血管紧张素转换酶(ACE)抑制剂、血管紧张素受体阻滞剂(ARBs)和肾素抑制剂,这些药物可防止血管紧张素原转化为血管紧张素。虽然全科医生和肾病学家很清楚肾素和醛固酮水平升高的原因和长期后果,但低肾素和/或低醛固酮水平的相反情况经常被低估。本综述的目的是为低肾素血症性高血压的不常见形式提供见解。方法:在PubMed在线图书馆中检索与低肾素血症性高血压相关的关键词,重点关注儿童人群。病理生理学方面,我们关注的是最近5年的文献。主要内容和发现:肾素和醛固酮水平低可能是遗传性(特别是当与低钾血症相关时)的指标,单基因形式的高血压刺激过多的小管钠和水吸收,随后导致血浆容量扩大和高血压。这些形式的高血压通常需要特殊的治疗方式。这强调了医生熟悉这些罕见疾病的重要性。结论:在这篇综述文章中,我们概述了以低肾素/低醛固酮和低肾素/高醛固酮水平为特征的不同形式的高血压,如何诊断这些形式的高血压,以及如何治疗它们。
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