This gap in knowledge is even more relevant when focusing on current antihypertensive treatment options, which mainly treat symptoms or have incompletely understood mechanisms of action. Despite the importance of arterial hypertension due to its high prevalence and immense impact on health worldwide, many details of the underlying pathological mechanisms leading to arterial hypertension remain unclear. Under this definition, the prevalence of arterial hypertension in the United States has soared from 32 to 46%.
To account for the importance of BP elevations that are less than the usual classification of arterial hypertension, the American Heart Association and American College of Cardiology decided to reclassify arterial hypertension as BP > 130/80 mmHg in their latest guidelines in 2017. The limit of 140/90 mmHg was chosen according to multiple randomized controlled clinical trials that showed clear benefits of antihypertensive treatment relative to potential treatment-associated adverse effects in response to the primary preventative treatment of BP > 140/90 mmHg. Due to multiple cardiovascular, renal, ocular and cognitive complications, arterial hypertension is a leading contributor to the global disease burden. Salt and inflammation are placed in the middle of the mosaic because both factors influence each of the remaining pieces.Īrterial hypertension, which is commonly defined as blood pressure (BP) > 140/90 mmHg, affects more than a quarter of the global population, which is more than one billion people worldwide. The purpose of this review is to propose a revised and extended version of the mosaic theory by summarizing and integrating recent advances in salt, immunity, and hypertension research. Some of these effects are mediated by changes in the microbiome and metabolome due to high-salt intake. Recent data show that sodium levels also modulate the function of monocytes/macrophages, dendritic cells, and different T-cell subsets. Sodium intake is indispensable for normal body function but can be detrimental when it exceeds dietary requirements. Inflammation plays an important role in the pathophysiology and contributes to the deleterious consequences of arterial hypertension.
Increasing evidence indicates that hypertension and hypertensive end-organ damage are not only mediated by the proposed mechanisms that result in hemodynamic injury. The mosaic theory of hypertension was advocated by Irvine Page ~80 years ago and suggested that hypertension resulted from the close interactions of different causes.
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