Agrest A
Academia Nacional de Medicina, Buenos Aires.
Medicina (B Aires). 2000;60(1):37-45.
This saga is the story of a scientific development. From the search of a mechanism to explain high blood pressure, research was orientated to the functions of an omnipresent biochemical system. And from the search to elucidate the etiology of arterial hypertension, research has ended up studying the local, functional and structural activity of the renin-angiotensin system and the possibilities of interfering with its actions. Since Bright, left ventricular hypertrophy became associated with nephrosclerosis. Later on, clinical studies led Volhard and Fahr to associate nephrosclerosis to high blood pressure while biochemical research led Tigerstedt and Bergmann to demonstrate that renin was associated to high blood pressure. Two teams of investigators, one in Argentina and one in USA discovered the biochemical mechanism by which renin acted on arterioles and later on, two other teams, one in USA and one in England, discovered the biochemical steps leading to the synthesis of angiotensin II. Since Goldblatt's experimental design resulting in a reliable method to obtain arterial hypertension, more than 20 years had to elapse before renal artery stenosis became established as the main cause of clinical secondary arterial hypertension. The renin-angiotensin system became part of a very complex array of substances able to regulate local circulation directly or indirectly and angiotensin has become involved in the remodeling of the smooth muscles of arterioles and myocardium.
这一传奇故事是关于一项科学发展的历程。从探寻解释高血压的机制开始,研究方向转向了一个无处不在的生化系统的功能。从阐明动脉高血压病因的探索出发,研究最终聚焦于肾素 - 血管紧张素系统的局部、功能和结构活性,以及干扰其作用的可能性。自布莱特之后,左心室肥厚与肾硬化症联系在了一起。后来,临床研究使福尔哈德和法尔将肾硬化症与高血压联系起来,而生化研究则使蒂格斯泰特和伯格曼证明肾素与高血压有关。两组研究人员,一组在阿根廷,一组在美国,发现了肾素作用于小动脉的生化机制,后来,另外两组,一组在美国,一组在英国,发现了导致血管紧张素 II 合成的生化步骤。自从戈德布拉特的实验设计产生了一种可靠的诱发动脉高血压的方法后,又过了 20 多年,肾动脉狭窄才被确立为临床继发性动脉高血压的主要病因。肾素 - 血管紧张素系统成为了一系列能够直接或间接调节局部循环的非常复杂的物质的一部分,并且血管紧张素已参与到小动脉和心肌平滑肌的重塑过程中。