Controversies in the pathophysiology of arterial hypertension.

A narrative review.

Abstract

Introduction: Purinergic receptors actively participate in the renal alterations in high blood pressure. The elevation of ATP in the renal interstitium activates purinergic receptors, constituting a fundamental pathway in the generation and persistence of arterial hypertension.

Objective of the review: This article is a narrative review that aims to show the importance of new concepts in the pathophysiology of arterial hypertension.

Essential points of the review:

Purinergic receptors are ATP receptors; the more significant the ATP, the greater the purinergic receptors.

Elevated ATP concentrations alter fundamental mechanisms related to blood pressure control, such as the pressure natriuresis mechanism and renal sodium excretion, the regulation of glomerular filtration, and the tubuloglomerular feedback mechanism. The alteration of these mechanisms decreases urinary sodium excretion.

Whether influenced by genetic alterations or induced by vasoconstrictor peptides, a decrease in renal function and tubulointerstitial injury occur before the glomerulus is injured.

The interaction between angiotensin II and purinergic receptors favors the progression of kidney damage.

Conclusion: Kidney damage in high blood pressure is critical, so efforts should be made to control hypertension to prevent the progression of kidney damage that leads to kidney failure. To obtain better blood pressure control, developing purinergic receptor antagonists for clinical use is possible.