Hypertension in Kidney Disease

Vascular tone and body fluid volume, the two dominant factors that determine arterial blood pressure, are controlled by the kidneys. Because of this, the kidneys play a central role in the regulation of normal arterial pressure and the development of hypertensive disorders [1–4]. Hypertension in kidney disease may be initiated by either increased cardiac output, increased total peripheral vascular resistance or both, but it is usually sustained by the latter [5–9]. The mechanism of the elevated total peripheral vascular resistance is multifactorial and complex. Although one mechanism, such as hyperreninemia or excessive sodium-fluid volume may be operational to initiate or maintain hypertension, it is more often that multiple mechanisms, in varying degrees at different stages, contribute to sustain hypertension [1, 3, 10–15] (Table 1).