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(Hypertension. 2004;44:27.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

A Genetic Predisposition to Hypertension?

From the Section of Nephrology, Yale University School of Medicine, New Haven, Conn.

Correspondence to David S. Geller, PO Box 208029, New Haven, CT 06520-8029. E-mail david.geller@yale.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Hypertension is a majorpublic health problem, and yet, the molecular mechanisms underlying hypertension are poorly understood in the majority of patients. A complex disorder, both environmental and genetic factors predispose individuals to hypertension. Whereas we know much about environmental factors, such as salt intake and exercise, that affect blood pressure, we know less about genetic factors that predispose individuals to hypertension. In recent years, there has been great progress in elucidating the molecular basis of monogenic disorders with primary effect on blood pressure, and this work has clarified many aspects of blood pressure regulation.¹ Among the most significant findings from this work has been that all known single-gene disorders with primary effect on blood pressure act via a single final common pathway-alteration of renal sodium reabsorption. These studies mirror what has been observed in acquired forms of hypertension, which uniformly feature increased sodium reabsorption as well. The sum of these findings is consistent with a large body of physiological work and animal studies drawing on the pioneering work of Arthur Guyton, who proposed that sustained hypertension ultimately required the active participation of the kidney.² The finding that all known inherited and acquired forms of hypertension ultimately operate via the same common pathway has led to the proposal that common forms of hypertension will feature perturbations in this pathway as well.¹

Although such work has greatly expanded our understanding of molecular mechanisms underlying hypertension, pathways determining this genetic predisposition to hypertension in the general population remain unknown. In recent years, there . . . [Full Text of this Article]

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