Pathogenesis of Hypertension in Blacks: Features of an Equilibrium Model

The mosaic theory continues to command the center of hypertension research. Burton (40) was the first to show that any theory for control of blood pressure must rest on some fundamental principles of equilibrium of the arterioles. Page (176) subsequently argued that the problem of hypertension may be “more realistically soluble in terms of altered equilibria than by any one of a variety of monistic approaches.” He later brought the theory to bear on renal hypertension (175,177), the center being the physical equilibrium of the arteriole, with factors such as genetic, environmental, anatomical, adaptive, neural, endocrine, humoral, and hemodynamic forming the margin. Thus, most theoretical discourse focuses on renal hypertension, because it has been acknowledged that the pathogenesis is very similar to human essential hypertension (18). The purpose of this chapter is to review the conceptual understanding of the problem of hypertension in general, taking renal hypertension as a marginal model for the pathogenesis of the disease in blacks.