Académie royale de Médecine de Belgique

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Résumé Jan Brod

Séance du samedi 27 novembre 1982)  

LES BASES HÉMODYNAMIQUES DE L’HYPERTENSION CHEZ LES MALADES RÉNAUX NON URÉMIQUES.

Enseignement qu’on peut en tirer quant à la pathogénie de l’hypertension en général.

par Jan BROD (Ecole de Médecine de Hanovre, République fédérale d’Allemagne), Correspondant étranger.

SUMMARY

97 patients with a chronic parenchymatous renal disease (GFR above 50 ml/min, Hb above 12,5 g%), 32 of whom were normotensive, were compmared in a haemodynamic study with 17 healthy controls. The first haemodynamic abnormality was apparent already in 12/32 normotensive renal patients. These consisted of an elevated resting cardiac index, a raised circulating blood volume to which the peripheral vascular bed had adjusted, the total and forearm vascular resistances being lowered and the venous compliance being elevated. Two to 8 years later 92% of these hyperkinetic but only 47% of the normokinetic originally normotensive subjects became hypertensive (bloof pressure repeatedly over 145/95 mm Hg). The blood pressure rose when the peripheral adjustment to the hyperkinetic state subsided. The circulating blood volume normalized at that stage. The disappearance of the vascular adjustment was due to a diminution of the vascular wall/lumen ratio and probably also to the mobilization of the “natriuretic factor” by the initial hypervolaemia. It is concluded that any time the ability of the kidney to maintain the volume of the extracellular fluid is restricted, blood pressure rises. The restores the volume homeostatic ability of the kidney but accelerates the development of degenerative vascular changes.

(Pas de résumé en français)