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Q J Med 1999; 92: 601-607
© 1999 Association of Physicians

Commentary papers

Salt, obesity, and alcohol fail to induce a lasting rise of blood pressure with age, and may be independent of renocortical vasculopathy

R.E. Tracy

From the Department of Pathology, Louisiana State University Medical Center, New Orleans, USA

Professor R.E. Tracy, Department of Pathology, Louisiana State University Medical Center, 1901 Perdido Street, New Orleans LA 70112, USA. e-mail: rtracy{at}lsumc.edu

Summary

Essential hypertension has a multitude of aetiologies, environmental circumstances that impact harmfully upon blood pressure levels. These aetiologies fall into two types: a reversible type that requires continuous exposure to the inciting agent to sustain the elevated blood pressure, and a persistent type which introduces some form of permanent change, presumably in body tissues. Available data on salt overload, obesity, and alcohol tend to cast these agents as reversible, without persistent effects. Agents of the reversible type emerge here as unlikely candidates for explaining the rise of blood pressure with age. Evidence reviewed here implicates intimal fibroplasia in renocortical arteries as the accumulated record that causes rising of blood pressure with age by Goldblatt mechanisms actuated through nephron heterogeneity. Such mechanisms could explain the persistent effects that propel the rise of blood pressure with age at varying rates among world-wide populations. These findings offer a new starting place for efforts to discover the aetiological agents that propel the rise of blood pressure with age, agents that apparently do not include salt, obesity, or alcohol.


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