Eknoyan Garabed
Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030 USA.
Adv Chronic Kidney Dis. 2004 Apr;11(2):192-6. doi: 10.1053/j.arrt.2004.01.001.
Elevated arterial pressure had long been surmised from the strength of the pulse. Its association with contracted kidneys and hypertrophied hearts was described by Richard Bright (1789-1858). Microscopic observations of the narrowed and obliterated vasculature initially observed in the kidneys of Bright's disease, and subsequently throughout the body, launched clinical research into hypertension. The description of these findings in the absence of symptoms of kidney disease led to the recognition of primary hypertension. Ultimately, the systematic recording of the blood pressure with a pneumatic cuff and mercury manometer established the significance of hypertension as a distinct disease entity. Subsequent experimental studies established the central role of the kidney in hypertension through the renin-angiotensin system and extracellular volume control. This finding provided the basis for the introduction of diuretics and angiotensin converting enzyme inhibitors, two of the most important and valuable antihypertertensive drugs now available. Thus, the study of kidney disease and function has played a pivotal role in the conceptual evolution of the understanding of hypertension as a disease, the identification of its mechanisms, and the development of clinically useful antihypertensive medications.
长期以来，人们一直从脉搏的强度推测动脉血压升高。理查德·布莱特（1789 - 1858）描述了动脉血压升高与肾脏萎缩和心脏肥大之间的关联。最初在布莱特氏病患者肾脏中观察到的血管狭窄和闭塞的微观表现，随后在全身各处都有发现，这引发了对高血压的临床研究。在没有肾病症状的情况下对这些发现的描述导致了原发性高血压的确认。最终，使用气动袖带和汞柱式血压计对血压进行系统记录，确立了高血压作为一种独特疾病实体的重要性。随后的实验研究通过肾素 - 血管紧张素系统和细胞外液量控制确定了肾脏在高血压中的核心作用。这一发现为利尿剂和血管紧张素转换酶抑制剂的引入提供了基础，这两种药物是目前最重要且最有价值的抗高血压药物。因此，对肾脏疾病和功能的研究在将高血压理解为一种疾病的概念演变、其发病机制的确定以及临床有用的抗高血压药物的开发中发挥了关键作用。
