DESPITE unequivocal evidence that renal function is altered in hypertension, certain important issues are unresolved. The most controversial area is whether the observed changes in renal function are a consequence of hypertension or the primary basis of the disease. Although there is little doubt that the kidney is progressively damaged as a longterm consequence of hypertension, 6 lines of evidence indicate that renal function is altered before the development of the disease and that some form of renal dysfunction is essential for the development and maintenance of hypertension.
These studies demonstrate that (1) the kidney plays a dominant role in the long-term control of blood pressure; (2) the induction of every experimental model of hypertension involves some maneuver that reduces renal excretory function, and certain changes, such as reduction of renal medullary blood flow, can be observed before the development of hypertension and in the absence of more global changes
Cowley AW, Roman RJ. The Role of the Kidney in Hypertension. JAMA. 1996;275(20):1581-1589. doi:10.1001/jama.1996.03530440061038