The gross and microscopic appearance of the kidneys of hypertensive patients dying of renal failure or any other complication such as coronary disease, heart failure or cerebral hemorrhage has been fairly well established from postmortem studies. The almost constant finding of renal arteriolar disease in these cases has led many people to believe that increased peripheral resistance to blood flow offered by generalized arteriolar disease, especially of the kidneys, is the cause of hypertension. Moritz and Oldt's1 comparative study of the arterioles of 100 hypertensive and 100 nonhypertensive persons showing that 97 per cent of the hypertensive and 12 per cent of the nonhypertensive persons had renal vascular disease seemed confirmatory evidence of this premise. The other school of thought is that the arteriolar disease is secondary to the hypertension, the cause of which is still unknown. The presence of severe arteriolar damage at the end stage of the disease,
CASTLEMAN B, SMITHWICK RH. THE RELATION OF VASCULAR DISEASE TO THE HYPERTENSIVE STATE: BASED ON A STUDY OF RENAL BIOPSIES FROM ONE HUNDRED HYPERTENSIVE PATIENTS. JAMA. 1943;121(16):1256–1261. doi:10.1001/jama.1943.02840160006002
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