May 1979

Renal Parenchymal DiseaseA Volume-Responsive Hypertension

Author Affiliations

Alton Ochsner Medical Foundation 1516 Jefferson Hwy New Orleans, LA 70121

Arch Intern Med. 1979;139(5):510. doi:10.1001/archinte.1979.03630420006004

During the past ten to 15 years, a number of studies have been reported that demonstrate a direct relationship between the level of arterial pressure and the expansion of extracellular fluid volumes in patients with hypertension and parenchymal disease of the kidney.1-5 This is even more apparent in those patients with absent renal excretory function in whom control of arterial pressure can be maintained by dialysis ultrafiltration.6,7 Only rarely does this hypertension seem to be related to increased plasma renin activity.

In the October Archives (138:1524-1529, 1978), Bank et al demonstrated prospectively that diuretic therapy in these patients with renal functional impairment and hypertension secondary to parenchymal disease will result in excellent control of arterial pressure, regardless of whether a thiazide or "loop" diuretic is used. Thus, although parenchymal renal disease with hypertension is generally accepted as a volume-dependent form of hypertension,8 the prospective testing of this mechanistic

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